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Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill

Alexis A Topjian¹, Ana M Gutierrez-Colina, Sarah M Sanchez

¹Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Critical Care Medicine

|November 21, 2012

Insights

Electrographic status epilepticus in critically ill children with acute encephalopathy significantly increases mortality and worsens neurologic outcomes. Electrographic seizures alone do not show this association, highlighting the importance of identifying status epilepticus.

Area of Science:

Pediatric Critical Care Medicine
Neuroscience
Epileptology

Background:

Electrographic seizures and status epilepticus are frequent in critically ill children.
Understanding their impact on mortality and neurological outcomes is crucial for patient management.

Purpose of the Study:

To investigate the association between electrographic seizures and electrographic status epilepticus with mortality.
To determine the link between these seizure types and short-term neurologic outcomes in critically ill children with acute encephalopathy.

Main Methods:

Prospective observational study in a pediatric intensive care unit (PICU).
Continuous electroencephalographic (EEG) monitoring for non-neonatal children with acute encephalopathy.
Statistical analysis including logistic regression to assess outcomes (mortality, neurologic worsening).

Main Results:

Electrographic status epilepticus was linked to a significantly higher risk of mortality (OR 5.1) and neurologic worsening (OR 17.3).
Electrographic seizures alone were not significantly associated with increased mortality or worsened neurologic outcomes.
18% of subjects died, and 44% experienced neurologic worsening.

Conclusions:

Electrographic status epilepticus is a significant independent risk factor for mortality and poor neurologic outcomes in critically ill children with acute encephalopathy.
Distinguishing between electrographic seizures and electrographic status epilepticus is critical for prognostication and treatment decisions.

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Abstract

Objectives:

Electrographic seizures and electrographic status epilepticus are common in critically ill children. We aimed to determine whether electrographic seizures and electrographic status epilepticus are associated with higher mortality or worse short-term neurologic outcome.

Design:

Prospective observational study.

Setting:

PICU of a tertiary children's hospital.

Patients:

Non-neonatal children admitted to a PICU with acute encephalopathy underwent continuous electroencephalographic monitoring. Electroencephalographs were scored as 1) no seizures, 2) electrographic seizures, or 3) electrographic status epilepticus. Covariates included age, acute neurologic disorder category, prior neurodevelopmental status, sex, and electroencephalographic background category. Outcomes were mortality and worsening of pediatric cerebral performance category from preadmission to PICU discharge. Chi-square analysis, Fisher's exact test, and multivariable logistic regression were used to evaluate the associations between electrographic seizures or electrographic status epilepticus and mortality or short-term neurologic outcome, using odds ratios and 95% confidence intervals.

Interventions:

None.

Main Results:

Two hundred children underwent continuous electroencephalographic monitoring. Eighty-four (42%) had seizures, which were categorized as electrographic seizures in 41 (20.5%) and electrographic status epilepticus in 43 (21.5%). Thirty-six subjects (18%) died, and 88 subjects (44%) had pediatric cerebral performance category worsening. In multivariable analysis, electrographic status epilepticus was associated with an increased risk of mortality (odds ratio 5.1; 95% confidence interval 1.4, 18; p = 0.01) and pediatric cerebral performance category worsening (odds ratio 17.3; 95% confidence interval 3.7, 80; p < 0.001), whereas electrographic seizures were not associated with an increased risk of mortality (odds ratio 1.3; 95% confidence interval 0.3, 5.1; p = 0.74) or pediatric cerebral performance category worsening (odds ratio 1.2; 95% confidence interval 0.4, 3.9; p = 0.77).

Conclusions:

Electrographic status epilepticus, but not electrographic seizures, is associated with mortality and worse short-term neurologic outcome in critically ill children with acute encephalopathy.

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