Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-23T13:10:31.467Z Has data issue: false hasContentIssue false

Chapter 11 - Screening for Seizures in At-Risk Pediatric Patients

from Part III - Practice of Neuromonitoring: Pediatric Intensive Care Unit

Published online by Cambridge University Press:  08 September 2022

By
Adam Wallace  and
Eric T. Payne
Edited by
Cecil D. Hahn  and
Courtney J. Wusthoff
Cecil D. Hahn
Affiliation:
The Hospital for Sick Children, University of Toronto
Courtney J. Wusthoff
Affiliation:
Lucile Packard Children’s Hospital, Stanford University
Get access

Summary

Neurological injury is extremely common among children admitted to the intensive care unit. The importance of recognizing and treating seizures in this vulnerable pediatric population is supported by a growing body of evidence, suggesting that seizures, both clinical and subclinical, negatively impact short- and long-term clinical outcomes. Continuous EEG monitoring offers the only noninvasive means to detect subclinical seizures and to confirm whether paroxysmal events suspicious for seizures do in fact represent clinical seizure activity. This chapter will discuss the evidence to support screening for seizures in specific disease states encountered in the PICU population where clinical and subclinical seizures are common. We begin by outlining the key clinical and EEG risk factors for the development of seizures shared by children admitted to the PICU across all etiologies. We then discuss the etiology-specific risk factors. Finally, considerations related to the timing and duration of cEEG monitoring are discussed.

Keywords

EEGCDSAQEEGseizureencephalopathycomastatus epilepticustraumatic brain injuryautoimmune encephalitisepidemiologyrisk factors
Type
Chapter
Information
Neuromonitoring in Neonatal and Pediatric Critical Care , pp. 149 - 156
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bell, MJ, Carpenter, J, Au, AK, et al. Development of a pediatric neurocritical care service. Neurocriti Care. 2009;10(1):4–10.CrossRefGoogle ScholarPubMed
Jette, N, Claassen, J, Emerson, RG, Hirsch, LJ. Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol. 2006;63(12):1750–5.CrossRefGoogle ScholarPubMed
Abend, NS, Gutierrez-Colina, AM, Topjian, AA, et al. Nonconvulsive seizures are common in critically ill children. Neurology. 2011;76(12):1071–7.CrossRefGoogle ScholarPubMed
Schreiber, JM, Zelleke, T, Gaillard, WD, et al. Continuous video EEG for patients with acute encephalopathy in a pediatric intensive care unit. Neurocrit Care, 2012;17(1):31–8.CrossRefGoogle Scholar
Abend, NS, Arndt, DH, Carpenter, JL, et al. Electrographic seizures in pediatric ICU patients: cohort study of risk factors and mortality. Neurology. 2013;81(4):383–91.Google Scholar
Payne, ET, Zhao, XY, Frndova, H, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014;137(Pt 5):1429–38.Google Scholar
Shahwan, A, Bailey, C, Shekerdemian, L, Harvey, AS. The prevalence of seizures in comatose children in the pediatric intensive care unit: a prospective video-EEG study. Epilepsia 2010;51(7):1198–1204.CrossRefGoogle ScholarPubMed
Kirkham, FJ, Wade, AM, McElduff, F, et al. Seizures in 204 comatose children: incidence and outcome. Intensive Care Med. 2012;38(5):853–62.Google Scholar
McCoy, B, Sharma, R, Ochi, A, et al. Predictors of nonconvulsive seizures among critically ill children. Epilepsia. 2011;52(11):1973–8.CrossRefGoogle ScholarPubMed
Williams, K, Jarrar, R, Buchhalter, J. Continuous video-EEG monitoring in pediatric intensive care units. Epilepsia. 2011;52(6):1130–6.CrossRefGoogle ScholarPubMed
Payne, ET, Hahn, CD. Continuous electroencephalography for seizures and status epilepticus. Current Opin Pediatr. 2014;26(6):675–81.Google Scholar
Bellinger, DC, Wypij, D, Rivkin, MJ, et al. Adolescents with d-transposition of the great arteries corrected with the arterial switch procedure: neuropsychological assessment and structural brain imaging. Circulation. 2011;124(12):1361–9.CrossRefGoogle ScholarPubMed
Gaynor, JW, Jarvik, GP, Gerdes, M, et al. Postoperative electroencephalographic seizures are associated with deficits in executive function and social behaviors at 4 years of age following cardiac surgery in infancy. J Thorac Cardiovasc Surg. 2013;146(1):132–7.CrossRefGoogle ScholarPubMed
Topjian, AA, Gutierrez-Colina, AM, Sanchez, SM, et al. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med. 2013;41(1):215–23.Google Scholar
Wagenman, KL, Blake, TP, Sanchez, SM, et al. Electrographic status epilepticus and long-term outcome in critically ill children. Neurology. 2014;82(5):396–404.Google Scholar
Srinivasakumar, P, Zempel, J, Trivedi, S, et al. Treating EEG seizures in hypoxic ischemic encephalopathy: a randomized controlled trial. Pediatrics. 2015;136(5):e1302–9.Google Scholar
Malone, A, Ryan, CA, Fitzgerald, A, et al. Interobserver agreement in neonatal seizure identification. Epilepsia. 2009;50(9):2097–2101.CrossRefGoogle ScholarPubMed
Payne, ET, McBain, K, Sharma, R, et al. Ability of ICU bedside caregivers to predict seizures among children who undergo continuous EEG monitoring. Ann Neurol. 2016;80(suppl 20):s316.Google Scholar
Dang, LT, Shellhaas, RA. Diagnostic yield of continuous video electroencephalography for paroxysmal vital sign changes in pediatric patients. Epilepsia. 2016;57(2):272–8.CrossRefGoogle ScholarPubMed
Barberio, M, Reiter, PD, Kaufman, J, Knupp, K, Dobyns, EL. Continuous infusion pentobarbital for refractory status epilepticus in children. J Child Neurol.2012;27(6):721–6.Google Scholar
Greiner, HM, Holland, K, Leach, JL, et al. Nonconvulsive status epilepticus: the encephalopathic pediatric patient. Pediatrics. 2012;129(3):e748–55.CrossRefGoogle ScholarPubMed
Holmes, GL. The long-term effects of neonatal seizures. Clin Perinatol. 2009;36(4):901–14, vii–viii.CrossRefGoogle ScholarPubMed
Payne, E, McBain, K, Hutchison, JS, et al. Detecting seizures among comatose children: interim results. J Clin Neurophysiol. 2013;226.Google Scholar
Westover, MB, Shafi, MM, Bianchi, MT, et al. The probability of seizures during EEG monitoring in critically ill adults. Clin Neurophysiol. 2015;126(3):463–71.CrossRefGoogle ScholarPubMed
Shafi, MM, Westover, MB, Cole, AJ, et al. Absence of early epileptiform abnormalities predicts lack of seizures on continuous EEG. Neurology. 2012;79(17):1796–1801.Google Scholar
Sanchez, SM, Arndt, DH, Carpenter, JL, et al. Electroencephalography monitoring in critically ill children: current practice and implications for future study design. Epilepsia. 2013;54(8):1419–27.Google Scholar
DeLorenzo, RJ, Waterhouse, EJ, Towne, AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.Google Scholar
Sanchez Fernandez, I, Abend, NS, Arndt, DH, et al. Electrographic seizures after convulsive status epilepticus in children and young adults: a retrospective multicenter study. J Pediatr. 2014;164(2):339–46 e331–2.Google Scholar
Arndt, DH, Lerner, JT, Matsumoto, JH, et al. Subclinical early posttraumatic seizures detected by continuous EEG monitoring in a consecutive pediatric cohort. Epilepsia. 2013;54(10):1780–8.CrossRefGoogle Scholar
O’Neill, BR, Handler, MH, Tong, S, Chapman, KE. Incidence of seizures on continuous EEG monitoring following traumatic brain injury in children. J Neurosurg. Pediatrics. 2015;16(2):167–76.CrossRefGoogle ScholarPubMed
Moreau, JF, Fink, EL, Hartman, ME, et al. Hospitalizations of children with neurologic disorders in the United States. Pediatr Crit Care Med. 2013;14(8):801–10.CrossRefGoogle ScholarPubMed
Chiaretti, A, De Benedictis, R, Polidori, G, et al. Early post-traumatic seizures in children with head injury. Childs Nerv Syst. 2000;16(12):862–6.Google Scholar
Hahn, YS, Fuchs, S, Flannery, AM, Barthel, MJ, McLone, DG. Factors influencing posttraumatic seizures in children. Neurosurgery. 1988;22(5):864–7.Google Scholar
Arango, JI, Deibert, CP, Brown, D, et al. Posttraumatic seizures in children with severe traumatic brain injury. Childs Nerv Syst. 2012;28(11):1925–9.CrossRefGoogle ScholarPubMed
Liesemer, K, Bratton, SL, Zebrack, CM, Brockmeyer, D, Statler, KD. Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features. J Neurotrauma. 2011;28(5):755–62.CrossRefGoogle ScholarPubMed
Hasbani, DM, Topjian, AA, Friess, SH, et al. Nonconvulsive electrographic seizures are common in children with abusive head trauma. Pediatr Crit Care Med. 2013;14(7):709–15.CrossRefGoogle ScholarPubMed
Vespa, PM, Miller, C, McArthur, D, et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med. 2007;35(12):2830–6.Google Scholar
Gallentine, WB. Utility of continuous EEG in children with acute traumatic brain injury. J Clin. Neurophysiol. 2013 30(2):126–33.CrossRefGoogle ScholarPubMed
Abend, NS, Beslow, LA, Smith, SE, et al. Seizures as a presenting symptom of acute arterial ischemic stroke in childhood. J Pediatr. 2011;159(3):479–83.Google Scholar
Singh, RK, Zecavati, N, Singh, J, et al. Seizures in acute childhood stroke. J Pediatr. 2012;160(2):291–6.Google Scholar
Payne, E, Yau, I, Frndova, H, et al. Prevalence of acute seizures and subsequent epilepsy among critically-ill children with acute ischemic stroke. Ann Neurol. 2016;S337.Google Scholar
Beslow, LA, Abend, NS, Gindville, MC, et al. Pediatric intracerebral hemorrhage: acute symptomatic seizures and epilepsy. JAMA Neurol. 2013;70(4):448–54.Google Scholar
Yang, JS, Park, YD, Hartlage, PL. Seizures associated with stroke in childhood. Pediatr Neurol.1995;12(2):136–8.Google Scholar
Lee, JC, Lin, KL, Wang, HS, et al. Seizures in childhood ischemic stroke in Taiwan. Brain Dev. 2009;31(4):294–9.Google Scholar
Zimmer, JA, Garg, BP, Williams, LS, Golomb, MR. Age-related variation in presenting signs of childhood arterial ischemic stroke. Pediatr Neurol. 2007;37(3):171–5.CrossRefGoogle ScholarPubMed
Chang, CJ, Chang, HW, Chang, WN, et al. Seizures complicating infantile and childhood bacterial meningitis. Pediatr Neurol. 2004;31(3):165–71.CrossRefGoogle ScholarPubMed
Gold, JJ, Crawford, JR, Glaser, C, et al. The role of continuous electroencephalography in childhood encephalitis. Pediatr Neurol. 2014;50(4):318–23.CrossRefGoogle ScholarPubMed
Carrera, E, Claassen, J, Oddo, M, et al. Continuous electroencephalographic monitoring in critically ill patients with central nervous system infections. Arch Neurol. 2008;65(12):1612–18.CrossRefGoogle ScholarPubMed
Fujita, K, Nagase, H, Nakagawa, T, et al. Non-convulsive seizures in children with infection-related altered mental status. Pediatr Int. 2015;57(4):659–64.Google Scholar
Florance, NR, Davis, RL, Lam, C, et al. Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol.2009;66(1):11–18.Google Scholar
Sands, TT, Nash, K, Tong, S, Sullivan, J. Focal seizures in children with anti-NMDA receptor antibody encephalitis. Epilepsy Res. 2015;112 :31–6.CrossRefGoogle ScholarPubMed
Schmitt, SE, Pargeon, K, Frechette, ES, et al. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012;79(11):1094–1100.CrossRefGoogle Scholar
Tenembaum, S, Chamoles, N, Fejerman, N. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology. 2002;59(8):1224–31.Google Scholar
Fridinger, SE, Alper, G. Defining encephalopathy in acute disseminated encephalomyelitis. J Child Neurol. 2014;29(6):751–5.Google Scholar
Payne, ET, Rutka, JT, Ho, TK, Halliday, WC, Banwell, BL. Treatment leading to dramatic recovery in acute hemorrhagic leukoencephalitis. J Child Neurol. 2007;22(1):109–13.Google Scholar
Bellinger, DC, Jonas, RA, Rappaport, LA, et al. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Eng J Med. 1995;332(9):549–55.Google Scholar
Clancy, RR, Sharif, U, Ichord, R, et al. Electrographic neonatal seizures after infant heart surgery. Epilepsia. 2005;46(1):84–90.CrossRefGoogle ScholarPubMed
Andropoulos, DB, Mizrahi, EM, Hrachovy, RA, et al. Electroencephalographic seizures after neonatal cardiac surgery with high-flow cardiopulmonary bypass. Anesth Analg. 2010;110(6):1680–5.CrossRefGoogle ScholarPubMed
Latal, B, Wohlrab, G, Brotschi, B, et al. Postoperative amplitude-integrated electroencephalography predicts four-year neurodevelopmental outcome in children with complex congenital heart disease. J Pediatr. 2016;178:55–60 e51.CrossRefGoogle ScholarPubMed
Piantino, JA, Wainwright, MS, Grimason, M, et al. Nonconvulsive seizures are common in children treated with extracorporeal cardiac life support. Pediatr Crit Care Med. 2013;14(6):601–9.Google Scholar
Abend, NS, Topjian, A, Ichord, R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72(22):1931–40.CrossRefGoogle ScholarPubMed
Abend, NS, Dlugos, DJ, Clancy, RR. A review of long-term EEG monitoring in critically ill children with hypoxic-ischemic encephalopathy, congenital heart disease, ECMO, and stroke. J Clin Neurophysiol. 2013;30(2):134–42.CrossRefGoogle ScholarPubMed
Chen, TH, Lin, WC, Tseng, YH, et al. Posterior reversible encephalopathy syndrome in children: case series and systematic review. J Child Neurol. 2013;28(11):1378–86.CrossRefGoogle ScholarPubMed
Cordelli, DM, Masetti, R, Ricci, E, et al. Life-threatening complications of posterior reversible encephalopathy syndrome in children. Eur J Paediatri Neurol. 2014;18(5):632–40.Google ScholarPubMed
Oddo, M, Carrera, E, Claassen, J, Mayer, SA, Hirsch, LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med. 2009;37(6):2051–6.Google Scholar
Press, C, Morgan, L, Mills, M, et al. Spectral electroencephalogram analysis for the evaluation of encephalopathy grade in children with acute liver failure. Pediatr Criti Care Med. 2017;18(1):64–72.CrossRefGoogle ScholarPubMed
Finkelstein, Y, Hutson, JR, Freedman, SB, Wax, P, Brent, J, Toxicology Investigators Consortium Case R. Drug-induced seizures in children and adolescents presenting for emergency care: current and emerging trends. Clin Toxicol. 2013;51(8):761–6.Google Scholar
Brophy, GM, Bell, R, Claassen, J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23.Google Scholar
Sanchez, SM, Carpenter, J, Chapman, KE, et al. Pediatric ICU EEG monitoring: current resources and practice in the United States and Canada. J Clin Neurophysiol. 2013;30(2):156–60.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×