Treatment of electrographic seizures and status epilepticus in critically ill children: A single center experience

Abstract Purpose Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in encephalopathic children in the pediatric intensive care unit (PICU) and associated with worse short-term outcome. Survey data indicate most physicians treat ES and ESE with antiepileptic drugs (A...

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Bibliographic Details
Published in:Seizure (London, England) England), 2013-07, Vol.22 (6), p.467-471
Main Authors: Abend, Nicholas S, Sanchez, Sarah M, Berg, Robert A, Dlugos, Dennis J, Topjian, Alexis A
Format: Article
Language:English
Subjects:
Anticonvulsant
Anticonvulsants - therapeutic use
Child
Child, Preschool
Critical Illness
Critically ill
Electroencephalogram
Electroencephalography
Female
Fosphenytoin
Humans
Infant
Intensive Care Units, Pediatric
Levetiracetam
Male
Neurology
Observation
Pediatric
Phenobarbital
Phenytoin
Retrospective Studies
Seizure
Seizures - drug therapy
Status epilepticus
Status Epilepticus - drug therapy
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Summary:Abstract Purpose Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in encephalopathic children in the pediatric intensive care unit (PICU) and associated with worse short-term outcome. Survey data indicate most physicians treat ES and ESE with antiepileptic drugs (AEDs), but few data are available regarding AED usage patterns. We aimed to describe AED usage for ES and ESE in critically ill children. Methods We performed an observational study of patients who underwent continuous electroencephalographic (cEEG) monitoring in the PICU of a single quaternary care children's hospital. We collected data regarding age, clinical diagnoses, ES and ESE occurrence, and AEDs utilized. Results 200 subjects underwent cEEG. ES occurred in 21% (41/200) and ESE occurred in 22% (43/200). Of the 84 patients with ES or ESE, 80 received non-benzodiazepine AEDs including 48% (38 of 80) with ES and 52% (42 of 80) with ESE. The most commonly administered first AEDs were levetiracetam in 38% (30/80), phenobarbital in 31% (25/80), phenytoin–fosphenytoin in 28% (22/80), and valproate in 4% (3/80). Seizures terminated after administration of the first AED in 74% (28/38) with ES and 22% (9/41) with ESE. Conclusions Levetiracetam, phenobarbital, and phenytoin–fosphenytoin are commonly used to manage ES and ESE at our center. Over half of subjects received multiple AEDs.
ISSN:1059-1311
1532-2688
DOI:10.1016/j.seizure.2013.03.008