Diagnostics and treatment of children with acute seizures on paediatric intensive care unit
Insights
Acute seizures in children admitted to the paediatric clinic are common, with a small percentage requiring paediatric intensive care unit (PICU) admission for severe or prolonged seizures. Genetic diagnoses were more frequent in severe, pharmacoresistant cases.
Area of Science:
- Pediatric Neurology
- Intensive Care Medicine
Background:
- Acute seizures are a common reason for pediatric clinic admissions.
- A subset of these children experience severe or prolonged seizures necessitating pediatric intensive care unit (PICU) admission.
Purpose of the Study:
- To analyze the characteristics and outcomes of children admitted for acute seizures.
- To identify factors associated with PICU admission and severe seizure courses.
Main Methods:
- Retrospective analysis of 218 children admitted for acute seizures over five years.
- Review of clinical data, seizure manifestations, PICU admission criteria, diagnoses, and treatment.
Main Results:
- 14% of children required PICU admission for repeated or prolonged seizures.
- Asymmetric clonic seizures were most frequent; hypoventilation/unconsciousness indicated PICU admission.
- Febrile seizures were common in less severe cases; genetic diagnoses were linked to severe, pharmacoresistant seizures.
Conclusions:
- While most acute seizures in children are manageable, a significant minority require intensive care.
- Genetic factors may play a role in severe and pharmacoresistant seizure presentations.
Abstract:
218 children were admitted to paediatric clinic for acute seizures within last 5 years. Out of them, 14 children (7%) were admitted to paediatric intensive care unit (PICU) with repeated or prolonged seizures. Two children were hospitalized twice. The average age of children in time of admission was 12 months, most of the children were healthy before admission, had normal psychomotor development. The most frequent seizure manifestation was asymmetric clonic seizure. Hypoventilation and/or unconsciousness was the most frequent indication for PICU admission in addition to seizures. Febrile seizure was the most frequent diagnosis in children with shorter or less frequent episodes of seizure. Children with severe course and pharmacoresistant seizure were likely to have genetic diagnosis. The MRI scan was normal in most of the children, interictal EEG was mostly without specific finding. Midazolam was the first lime anticonvulsive medication used in most of the children, while phenobarbital, levetiracetam or phenytoin were the preferred second line drugs. Keywords: acute seizures, asymmetric clonic seizure, febrile seizure, children, paediatric intensive care unit.
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