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Published on: June 23, 2022
The Utility of Infectious and Neurodiagnostic Testing in Children With Complex Febrile Seizures Requiring Mechanical
Jennifer H Yang1,2, Richard Villegas3,2, Sandeep Khanna3,2
1Department of Neurosciences, 8784University of California, San Diego, CA, USA.
Insights
Extensive diagnostic evaluations may not be necessary for children with complex febrile seizures requiring mechanical ventilation. Further research is needed to understand the role of electroencephalogram (EEG) in these cases.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
Background:
- Complex febrile seizures can be severe, sometimes requiring mechanical ventilation.
- The necessity of extensive diagnostic workups in these pediatric cases remains unclear.
Purpose of the Study:
- To evaluate the utility of infectious and neurologic diagnostic tests in children with complex febrile seizures needing mechanical ventilation.
- To assess the impact of these diagnostics on patient outcomes and identify predictors for conditions like epilepsy.
Main Methods:
- Retrospective cohort analysis of 79 pediatric patients (6 months–5 years) requiring mechanical ventilation for complex febrile seizures.
- Data collected on diagnostic tests performed, intensive care unit (ICU) stay, interventions, and long-term follow-up for epilepsy diagnosis.
Main Results:
- Most patients had short ICU stays; no life-threatening infections or surgical interventions were identified.
- Electroencephalogram (EEG) was performed in 43%, with abnormalities in 26%. 10% of patients were later diagnosed with epilepsy.
- Many patients were discharged with benzodiazepines or antiseizure medications.
Conclusions:
- Extensive infectious and neurologic diagnostics may not be essential for children with complex febrile seizures requiring mechanical ventilation.
- The diagnostic value of EEG in this population warrants further investigation.
- Long-term epilepsy risk is present in a subset of these children.
Abstract:
A retrospective cohort analysis was performed on 79 consecutive patients between 6 months and 5 years admitted to a tertiary hospital with a diagnosis of complex febrile seizures requiring mechanical ventilation from 2011 to 2017 to determine the utility of infectious and neurologic diagnostics. Intubation was used as a proxy for severity of illness. The overall intensive care unit stay was short (95% intubated <24 hours, 88% admitted <3 days). No life-threatening infections were identified, and none required surgical interventions. Electroencephalogram (EEG) was obtained on 43%, 26% of which were abnormal. Sixty-six percent of patients were discharged on rescue benzodiazepine and 20% with maintenance antiseizure medications. Duration of follow-up averaged 4 years (range 1 month to 9 years); 8 patients (10%) were subsequently diagnosed with epilepsy. Our findings suggest that extensive diagnostic evaluations may not be necessary for children with complex febrile seizures requiring mechanical ventilation although the role of EEG is less understood.
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