Electrographic Seizures and Outcome in Critically Ill Children

Area of Science:

• Pediatric Critical Care Medicine
• Neurocritical Care
• Epileptology

Background:

• Acute encephalopathy in critically ill children is associated with significant morbidity.
• Continuous EEG monitoring (CEEG) is crucial for detecting electroencephalographic seizures (ES) and electroencephalographic status epilepticus (ESE).
• Understanding the impact of ES and ESE on neurobehavioral outcomes is vital for guiding treatment strategies.

Purpose of the Study:

• To investigate the association between exposure to ES and ESE and unfavorable neurobehavioral outcomes in critically ill children with acute encephalopathy.
• To determine if ES or ESE impacts mortality in this patient population.

Main Methods:

• Prospective cohort study of 719 critically ill children with acute encephalopathy undergoing CEEG.
• Patients were categorized based on ES/ESE exposure: none, ES, or ESE.
• Neurobehavioral outcomes (GOS-E-Peds, PCPC) and mortality were assessed at discharge using multivariate logistic regression.

Main Results:

• ESE was associated with unfavorable GOS-E-Peds (OR 2.21) and PCPC (OR 2.17) scores.
• No association was found between ESE and mortality.
• Electroencephalographic seizures (ES) were not associated with unfavorable neurobehavioral outcomes or mortality.

Conclusions:

• Electroencephalographic status epilepticus (ESE) is a significant risk factor for poor neurobehavioral outcomes in critically ill children with acute encephalopathy.
• Electroencephalographic seizures (ES) alone do not appear to confer an increased risk of adverse neurobehavioral outcomes or mortality in this population.
• Continuous EEG monitoring is essential for identifying ESE and informing prognosis in pediatric acute encephalopathy.