Continuous electroencephalography for seizures and status epilepticus.

Area of Science:

• Pediatric Neurology
• Critical Care Medicine
• Neurophysiology

Background:

• Critically ill children are at high risk for electrographic seizures and status epilepticus.
• Subclinical seizures are prevalent in encephalopathic children with acute brain injury.
• Seizure burden and status epilepticus are linked to adverse outcomes.

Purpose of the Study:

• To review the utilization of continuous video-electroencephalographic (cEEG) monitoring in critically ill children.
• To highlight the importance of cEEG in identifying electrographic seizures and status epilepticus.
• To discuss the implications of cEEG findings on patient outcomes.

Main Methods:

• Review of recent North American pediatric institutional practices for cEEG monitoring.
• Analysis of evidence linking seizure burden and status epilepticus to patient outcomes.
• Synthesis of current understanding regarding the diagnosis and management of electrographic seizures.

Main Results:

• cEEG monitoring use is increasing but varies across pediatric institutions.
• Subclinical seizures are common, especially in encephalopathic patients with acute brain injury.
• Increased seizure burden and status epilepticus correlate with poorer short-term and long-term outcomes.

Conclusions:

• cEEG monitoring is essential for diagnosing and managing electrographic seizures and status epilepticus in high-risk children.
• While seizure burden impacts outcomes, further research is needed to confirm if aggressive antiepileptic drug treatment improves results.
• The role of cEEG in guiding therapeutic interventions requires further investigation.