Abstract Details

Title Clinical and EEG Determinants of Electroencephalographic Seizures in Critically Ill Children

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S31 - Epilepsy/Clinical Neurophysiology (EEG) 3 (3:42 PM-3:54 PM)

Poster/Presentation
Number 002

Objective

We aimed to determine the optimal duration of CEEG for ES identification using clinical and EEG predictors in critically ill children.

Background Electrographic seizure (ES) are common in critically ill children and detection often requires resource-intense continuous EEG monitoring (CEEG). Prediction models that stratify patients by ES risk could allow clinicians to implement personalized and targeted strategies in which limited CEEG resources are directed to appropriate patients for appropriate durations.

Design/Methods We performed a single-center prospective observational cohort study of 719 consecutive critically ill children with acute encephalopathy. We evaluated baseline clinical risk factors (age and prior clinical seizures) and time-dependent risk factors observed during CEEG in a multi-state (entry, EEG risk, ES) survival model. For each subgroup, we determined the CEEG duration at which the risk of ES was <5%.

Results ES occurred in 184 children (26%). Patients aged >1 year without prior seizures or EEG risk factors achieved <5% risk of ES after about 6 hours of CEEG. Patients aged <1 year without prior seizures or EEG risk factors and patients aged >1 year with either prior seizures or EEG risk factors achieved <5% risk of ES after about one day of CEEG. Patients aged >1 year with both prior seizures and EEG risk factors and patients aged <1 year without prior seizures but with EEG risk factors achieved <5% risk of ES after about two days of CEEG. Patients aged <1 year with prior seizures achieved <5% risk of ES after about 2.5 days of CEEG irrespective of EEG risk factors.

Conclusions A model derived from two baseline clinical risk factors (age and prior clinically evident seizures) along with emergent EEG risk factors would allow clinicians to implement personalized CEEG strategies that optimally utilize limited CEEG resources. This would enable more widespread implementation of CEEG-guided management as part of neuroprotective strategies.

Authors/Disclosures
France W. Fung, MD (Children's Hospital of Philadelphia) PRESENTER	Dr. Fung has nothing to disclose.
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Nicholas S. Abend, MD, FAAN (Children's Hospital of Philadelphia)	Dr. Abend has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Epilepsy Foundation. The institution of Dr. Abend has received research support from NIH. The institution of Dr. Abend has received research support from PCORI. Dr. Abend has received publishing royalties from a publication relating to health care.

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