Electrographic Seizures Following Status Epilepticus With Fever in Critically Ill Children

Area of Science:

• Pediatric Neurology
• Critical Care Medicine
• Epileptology

Background:

• Electrographic seizures (ESzs) post-status epilepticus (SE) affect critically ill children, often within 48 hours, and correlate with adverse neurological outcomes.
• Status epilepticus with fever is common in pediatric cases, yet ESz in this specific subgroup remain understudied.

Purpose of the Study:

• To characterize the frequency, timing, and prognostic significance of ESz in children experiencing SE with fever.
• To investigate ESz occurrence and outcomes specifically within the febrile status epilepticus subgroup.

Main Methods:

• Retrospective analysis of pediatric intensive care unit patients with SE and fever (2017-2023).
• Continuous electroencephalography (cEEG) monitoring was employed per American Clinical Neurophysiology Society guidelines.
• Univariate analysis identified factors associated with ESz and poor prognosis, with a subgroup analysis for febrile status epilepticus.

Main Results:

• Of 83 patients with SE and fever, 39 underwent cEEG, revealing ESz in 7 patients (18%).
• Three ESz cases were detected beyond 48 hours post-onset. All patients with ESz experienced poor outcomes, compared to 25% without ESz (P < 0.01).
• Within the 15 patients meeting febrile status epilepticus criteria, 3 (20%) had ESz, all with poor outcomes.

Conclusions:

• ESz occurred in 18% of children with SE and fever, significantly associated with unfavorable prognoses, including late-onset cases.
• Findings suggest prolonged cEEG monitoring could be beneficial for early detection and management of ESz in this vulnerable pediatric population.