Electrographic Seizures Following Status Epilepticus With Fever in Critically Ill Children

Electrographic seizures (ESzs) following status epilepticus (SE) occur in 26-57% of critically ill children, typically within 48 hours of onset, and are associated with adverse neurological outcomes. Although SE with fever accounts for 40-49% of pediatric SE, few studies have focused on ESz in this subgroup. We conducted a single-center retrospective study to characterize the frequency, timing, and prognostic implications of ESz following SE with fever.

We retrospectively reviewed patients admitted to our pediatric intensive care unit with SE with fever between 2017 and 2023. Continuous electroencephalography (cEEG) was performed in accordance with American Clinical Neurophysiology Society guidelines. Univariate analysis identified factors associated with ESz and poor prognosis. A subgroup analysis was conducted for patients who met the criteria for febrile status epilepticus.

In total, 83 patients were admitted with SE with fever; cEEG was recorded in 39. ESz were detected in seven patients (18%), including three detected more than 48 hours after onset. All seven patients with ESz had poor outcomes, whereas 25% (8/32) of those without ESz had poor outcomes (P < 0.01). Among the 15 patients meeting febrile status epilepticus criteria, ESz occurred in three (20%), all of whom had poor outcomes.

In this cohort, ESz occurred in 18% of children following SE with fever and were associated with an unfavorable prognosis, including cases appearing more than 48 hours after onset. These findings suggest that prolonged cEEG monitoring may be useful for early detection and management of ESz in this population.