Electrographic Status Epilepticus and Long-term Outcome in Critically Ill Children

In the February 4, 2014, Neurology ahead of press, Dr. Wagenman and a team of investigators from the Children’s Hospital in Philadelphia present an analysis in which they assess what happens to children who are critically ill and present with seizures only on the EEG and to children who have status epilepticus as diagnosed only on the EEG.

• In the observational study, 300 children with acute neurological conditions underwent clinically indicated EEG monitoring.
  • Over time, 137 of these individuals who were neurodevelopmentally normal were followed to understand the impact their seizures had on their long-term outcome.
  • Of the 137 subjects 60 or 44% were followed for up to 2.7 years.
• Electrographic seizures occurred in 20% or 12 subjects; whereas electrographic status epilepticus occurred in 14 subjects or 23%.
• A multivariate analysis indicated that electrographic status epilepticus was associated with an increased risk of unfavorable Glasgow Outcome Scale and lower Pediatric Quality of Life Inventory scores.
• Among patients without prior epilepsy diagnosis, electrographic status epilepticus was associated with an increased risk of subsequently diagnosed epilepsy; however, electrographic seizures were not associated with worse outcomes.
• The authors concluded that among children with acute neurological disorders who were reported to be neurodevelopmentally normal before admission to the pediatric ICU, electrographic status epilepticus, but not electrographic seizures, was associated with an increased risk of unfavorable outcome, a lower quality of life score, and an increased risk of subsequently diagnosed epilepsy even after adjusting for EEG background categories and age.