Neurocritical Care

, Volume 17, Issue 1, pp 31–38 | Cite as

Continuous Video EEG for Patients with Acute Encephalopathy in a Pediatric Intensive Care Unit

  • John M. Schreiber
  • Tesfaye Zelleke
  • William D. Gaillard
  • Himanshu Kaulas
  • Nathan Dean
  • Jessica L. Carpenter
Original Article
First Online:

Abstract

Objectives

In this study, we aimed to determine the incidence of electrographic seizures among patients in a pediatric intensive care unit (PICU) presenting with acute encephalopathy. Risk factors and duration of continuous EEG monitoring needed to capture electrographic seizures were also assessed.

Study Design

Based on a NeuroICU clinical care pathway, all patients with acute encephalopathy admitted to the PICU are monitored with continuous video electroencephalogram (cVEEG) for 48 h or until the encephalopathy improves. Ninety-four consecutive patients included on the pathway over a year were identified. Mean age was 6.7 years (range 32 days–17.9 years). Data pertaining to patient clinical information and electrographic seizures, including non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE), were extracted from a prospective database.

Results

Thirty percent (28/94) had seizures captured on cVEEG including 17 patients (18 %) with NCSE. Variables associated with electrographic seizures were age <24 months and clinical seizure(s) prior to EEG placement. The first seizure captured on cVEEG occurred in the first 24 h for the majority of patients (97 %). Acute brain injury and electrographic seizures were associated with worse outcome.

Conclusions

Electrographic seizures are common in pediatric patients with acute encephalopathy. This study supports the practice of cVEEG monitoring for at least 24 h in pediatric patients with acute encephalopathy, particularly if they are less then 24 months of age and/or if a clinical event suspicious for seizure precedes the encephalopathy.

Keywords

Electroencephalogram (EEG) Seizure Non-convulsive Status epilepticus Encephalopathy 

Abbreviations

EEG

Electroencephalogram

cVEEG

Continuous video EEG

ABI

Acute brain injury

CNS

Central nervous system

TBI

Traumatic brain injury

NCS

Non-convulsive seizure

NCSE

Non-convulsive status epilepticus

PICU

Pediatric intensive care unit

GCS

Glasgow coma scale

AED

Antiepileptic drug

GOS-E Peds

Glasgow Outcome Scale-Extended, Pediatric revision

PCPC

Pediatric cerebral performance category

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Notes

Acknowledgments

We thank Prof. Zerihun Tadesse for statistical support.

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • John M. Schreiber
    • 1
  • Tesfaye Zelleke
    • 1
  • William D. Gaillard
    • 1
  • Himanshu Kaulas
    • 1
  • Nathan Dean
    • 2
  • Jessica L. Carpenter
    • 1
  1. 1.Department of Epilepsy, Neurophysiology, and Critical Care NeurologyGeorge Washington University School of Medicine and Health Sciences and the Children’s National Medical CenterWashingtonUSA
  2. 2.Department of Critical Care MedicineGeorge Washington University School of Medicine and Health Sciences and the Children’s National Medical CenterWashingtonUSA

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