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Clinical Features and Management of Status Epilepticus in the Pediatric Intensive Care Unit

Ekin Soydan1, Yigithan Guzin2, Sevgi Topal1

  • 1From the Pediatric Intensive Care Unit.

Pediatric Emergency Care
|February 15, 2023
PubMed

Insights

Pediatric status epilepticus (SE) in the ICU is a serious condition. Continuous electroencephalographic monitoring is crucial for recognizing seizures and enabling rapid intervention, though treatment superiority remains unproven.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Epileptology

Background:

  • Status epilepticus (SE) in children admitted to the pediatric intensive care unit (PICU) presents significant morbidity and mortality risks.
  • Characterizing SE in the PICU is essential for improving patient outcomes.

Purpose of the Study:

  • To retrospectively analyze the clinical features and treatment of pediatric patients experiencing SE in a PICU setting.
  • To identify key characteristics and outcomes associated with SE in critically ill children.

Main Methods:

  • Retrospective review of 88 pediatric patients (1 month to 18 years) diagnosed with SE between January 2015 and December 2019.
  • Utilized continuous electroencephalographic (EEG) monitoring to classify seizure activity (lateralized, multifocal, generalized, bilateral independent).
  • Analyzed data on convulsive (CSE) versus nonconvulsive status epilepticus (NCSE), refractory SE, and super-refractory SE.

Main Results:

  • The study included 88 patients, with 56.8% being boys. Median age was 24 months.
  • EEG monitoring revealed diverse seizure origins: 30.7% lateralized, 22.7% multifocal, 34.1% generalized, and 12.5% bilateral independent.
  • Nonconvulsive SE (NCSE) was associated with higher Pediatric Risk of Mortality (PRISM III) scores and increased mortality (P=0.004, P=0.046 respectively). Refractory SE and super-refractory SE were diagnosed in 43.1% and 13.6% of patients, respectively. Overall mortality was 10.2%.

Conclusions:

  • Status epilepticus is a critical neurological emergency in children, contributing to mortality and morbidity.
  • Continuous EEG monitoring is vital for accurate seizure recognition and timely therapeutic interventions.
  • Current evidence does not support the superiority of specific second-line or combined treatments for pediatric SE.
Abstract

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