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Electroencephalographic Seizures in Critically Ill Children: Management and Adverse Events
- Source :
- Epilepsia
- Publication Year :
- 2019
-
Abstract
- Objective Guidelines recommend that encephalopathic critically ill children undergo continuous electroencephalographic (CEEG) monitoring for electrographic seizure (ES) identification and management. However, limited data exist on antiseizure medication (ASM) safety for ES treatment in critically ill children. Methods We performed a single-center prospective observational study of encephalopathic critically ill children undergoing CEEG. Clinical and EEG features and ASM utilization patterns were evaluated. We determined the incidence, types, and risk factors for adverse events associated with ASM administration. Results A total of 472 consecutive critically ill children undergoing CEEG were enrolled. ES occurred in 131 children (28%). Clinicians administered ASM to 108 children with ES (82%). ES terminated after the initial ASM in 38% of patients who received one ASM, after the second ASM in 35% of patients who received two ASMs, after the third ASM in 50% of patients who received three ASMs, and after the fourth ASM in 53% of patients who received four ASMs. Thirty patients (28%) received anesthetic infusions for ES management. Adverse events occurred in 18 patients (17%). Adverse effects were expected and resolved in all patients, and they were generally serious (in 15 patients) and definitely related (in 12 patients). Adverse events were rare in patients with acute symptomatic seizures requiring only one to two ASMs for treatment, but were more common in children with epilepsy, ictal-interictal continuum EEG patterns, or patients requiring more extensive ASM management. Significance ES ceased after one ASM in only 38% of critically ill children but ceased after two ASMs in 73% of critically ill children. Thus, ES management was often accomplished with readily available medications, but optimization of multistep ES management strategies might be beneficial. Adverse events were rare and manageable in children with acute symptomatic seizures requiring only one to two ASMs for treatment. Future studies are needed to determine whether management of acute symptomatic ES improves neurobehavioral outcomes.
- Subjects :
- 0301 basic medicine
Male
Pediatrics
medicine.medical_specialty
Adolescent
Critical Illness
Status epilepticus
Electroencephalography
Severity of Illness Index
Article
03 medical and health sciences
Epilepsy
0302 clinical medicine
Risk Factors
Seizures
Medicine
Humans
Prospective Studies
Adverse effect
Child
Monitoring, Physiologic
medicine.diagnostic_test
business.industry
Critically ill
Incidence (epidemiology)
Brain
Infant
Symptomatic seizures
respiratory system
medicine.disease
musculoskeletal system
respiratory tract diseases
030104 developmental biology
Neurology
Child, Preschool
Observational study
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Epilepsia
- Accession number :
- edsair.doi.dedup.....811096d85ec5f4ffbde6403325290cd3