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Continuous electroencephalography for seizures and status epilepticus
1aDivision of Neurology, The Hospital for Sick Children bDepartment of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Insights
Continuous video-electroencephalographic (cEEG) monitoring is crucial for critically ill children at risk for silent seizures. Early detection and management of electrographic seizures and status epilepticus are vital for improving patient outcomes.
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.
Purpose Of Review:
To discuss the use of continuous video-electroencephalographic (cEEG) monitoring among critically ill children at risk for electrographic seizures and status epilepticus.
Recent Findings:
Recent reports have demonstrated the growing, but heterogeneous, use of cEEG monitoring among North American pediatric institutions, and provided evidence for the high prevalence of subclinical seizures, particularly among encephalopathic patients with acute brain injury. Increasing seizure burden and status epilepticus have been shown to be independently associated with worse short-term and long-term outcomes.
Summary:
Certain high-risk children frequently experience electrographic seizures and status epilepticus, often without clinical signs, necessitating the use of cEEG monitoring for their diagnosis and management. Although an increasing electrographic seizure burden and status epilepticus are independently associated with worse outcome, further studies are needed to determine whether aggressive use of antiepileptic drugs to reduce seizure burden can improve outcome.
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