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Treatment of electrographic seizures and status epilepticus in critically ill children: a single center experience

Nicholas S Abend1, Sarah M Sanchez, Robert A Berg

  • 1Division of Neurology, The Perelman School of Medicine at the University of Pennsylvania, USA. abend@email.chop.edu

Seizure
|April 23, 2013
PubMed

Insights

Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in critically ill children. Levetiracetam, phenobarbital, and phenytoin-fosphenytoin are frequently used antiepileptic drugs (AEDs) for treatment.

Area of Science:

  • Pediatric intensive care
  • Neurocritical care
  • Epileptology

Background:

  • Electrographic seizures (ES) and electrographic status epilepticus (ESE) are prevalent in encephalopathic children within the pediatric intensive care unit (PICU).
  • These seizure types are linked to poorer short-term outcomes.
  • Limited data exist on antiepileptic drug (AED) usage patterns for ES and ESE.

Purpose of the Study:

  • To characterize AED utilization for managing ES and ESE in critically ill children.
  • To identify common AEDs prescribed for these conditions.

Main Methods:

  • An observational study was conducted involving patients undergoing continuous electroencephalographic (cEEG) monitoring in a PICU.
  • Data collected included patient demographics, clinical diagnoses, occurrence of ES/ESE, and AEDs administered.

Main Results:

  • Of 200 subjects, 21% experienced ES and 22% experienced ESE.
  • Levetiracetam (38%), phenobarbital (31%), and phenytoin-fosphenytoin (28%) were the most common first-line AEDs for ES/ESE.
  • Seizure termination after the first AED varied, with higher success rates for ES (74%) compared to ESE (22%).

Conclusions:

  • Levetiracetam, phenobarbital, and phenytoin-fosphenytoin are frequently employed AEDs for ES and ESE in the PICU setting.
  • A significant proportion of patients required multiple AEDs for seizure management.
Abstract

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