Management of Status Epilepticus and Recurrent Seizures

doi:10.1017/9781316536001.010

Chapter 10 - Management of Status Epilepticus and Recurrent Seizures

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

Published online by Cambridge University Press: 08 September 2022

Marina Gaínza-Lein ,

Iván Sánchez Fernández and

Tobias Loddenkemper

Edited by

Cecil D. Hahn and

Courtney J. Wusthoff

Show author details

Cecil D. Hahn: Affiliation:
The Hospital for Sick Children, University of Toronto
Courtney J. Wusthoff: Affiliation:
Lucile Packard Children’s Hospital, Stanford University

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Summary

Status epilepticus is a life-threatening and time-sensitive emergency. Continuous EEG monitoring allows the detection of electrographic seizures and electrographic status epilepticus. Increasing evidence guides best practices for which patients to monitor for these conditions and appropriate duration of monitoring. The treatment of SE consists of benzodiazepines, non-benzodiazepines, antiepileptic drugs, and continuous infusions; cEEG monitoring is helpful in assessing the response to treatment. Interpretation of EEG after electrographic seizures requires care, as some patterns on the ictal-interictal continuum may be challenging. This chapter reviews current evidence regarding neuromonitoring and the management of status epilepticus and recurrent seizures.

Keywords

Electrographic seizures status epilepticus cEEG ictal-interictal continuum treatment anti-seizure medication

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Type: Chapter
Information: Neuromonitoring in Neonatal and Pediatric Critical Care , pp. 137 - 148

DOI: https://doi.org/10.1017/9781316536001.010 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2022

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References

Abend, NS, Chapman, KE, Gallentine, WB, et al. Electroencephalographic monitoring in the pediatric intensive care unit. Curr Neurol Neurosci Rep. 2013;13(3):330.CrossRef Google Scholar PubMed

Lothman, E. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990;40(5 Suppl 2):13–23.Google Scholar

Meldrum, BS, Horton, RW. Physiology of status epilepticus in primates. Arch Neurol. 1973;28(1):1–9.CrossRef Google Scholar PubMed

Lowenstein, DH, Bleck, T, Macdonald, RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40(1):120–2.Google Scholar

Tsuchida, TN, Wusthoff, CJ, Shellhaas, RA, et al. American clinical neurophysiology society standardized EEG terminology and categorization for the description of continuous EEG monitoring in neonates: report of the American Clinical Neurophysiology Society critical care monitoring committee. J Clin Neurophysiol. 2013;30(2):161–73.CrossRef Google Scholar PubMed

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.CrossRef Google Scholar PubMed

Loddenkemper, T, Goodkin, HP. Treatment of pediatric status epilepticus. Curr Treat Options Neurol. 2011;13(6):560–73.CrossRef Google Scholar PubMed

Chin, RF, Neville, BG, Scott, RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol. 2004;11(12):800–10.Google Scholar

DeLorenzo, RJ, Hauser, WA, Towne, AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46(4):1029–35.Google Scholar

Hesdorffer, DC, Logroscino, G, Cascino, G, Annegers, JF, Hauser, WA. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology. 1998;50(3):735–41.Google Scholar

Abend, NS, Gutierrez-Colina, AM, Topjian, AA, et al. Nonconvulsive seizures are common in critically ill children. Neurology. 2011;76(12):1071–7.Google Scholar

Hosain, SA, Solomon, GE, Kobylarz, EJ. Electroencephalographic patterns in unresponsive pediatric patients. Pediatr Neurol. 2005;32(3):162–5.Google Scholar

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.Google Scholar

Abend, NS, Dlugos, DJ. Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol. 2007;37(3):165–70.Google Scholar

Alehan, FK, Morton, LD, Pellock, JM. Utility of electroencephalography in the pediatric emergency department. J Child Neurol. 2001;16(7):484–7.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):1198–204.Google Scholar

Williams, K, Jarrar, R, Buchhalter, J. Continuous video-EEG monitoring in pediatric intensive care units. Epilepsia. 2011;52(6):1130–6.Google Scholar

Kirkham, FJ, Wade, AM, McElduff, F, et al. Seizures in 204 comatose children: incidence and outcome. Intensive Care Med. 2012;38(5):853–62.CrossRef Google Scholar PubMed

Abend, NS, Topjian, A, Ichord, R, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology. 2009;72(22):1931–40.Google Scholar

Tay, SK, Hirsch, LJ, Leary, L, et al. Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia. 2006;47(9):1504–9.Google Scholar

Greiner, HM, Holland, K, Leach, JL, et al. Nonconvulsive status epilepticus: the encephalopathic pediatric patient. Pediatrics. 2012;129(3):e748–55.CrossRef Google Scholar PubMed

Saengpattrachai, M, Sharma, R, Hunjan, A, et al. Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia. 2006;47(9):1510–18.Google Scholar

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

Abend, NS. Electrographic status epilepticus in children with critical illness: epidemiology and outcome. Epilepsy Behav. 2015;49:223–7.Google 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

Claassen, J, Mayer, SA, Kowalski, RG, Emerson, RG, Hirsch, LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62(10):1743–8.Google Scholar

Towne, AR, Waterhouse, EJ, Boggs, JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54(2):340–5.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 e1-2.CrossRef Google Scholar

Loddenkemper, T, Syed, TU, Ramgopal, S, et al. Risk factors associated with death in in-hospital pediatric convulsive status epilepticus. PLoS ONE. 2012;7(10):e47474.Google Scholar

Maytal, J, Shinnar, S, Moshe, SL, Alvarez, LA. Low morbidity and mortality of status epilepticus in children. Pediatrics. 1989;83(3):323–31.CrossRef Google Scholar PubMed

Sanchez Fernandez, I, Abend, NS, Agadi, S, et al. Time from convulsive status epilepticus onset to anticonvulsant administration in children. Neurology. 2015;84(23):2304–11.Google Scholar

Coeytaux, A, Jallon, P, Galobardes, B, Morabia, A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000;55(5):693–7.Google Scholar

Knake, S, Rosenow, F, Vescovi, M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia. 2001;42(6):714–18.Google Scholar

Martinos, MM, Yoong, M, Patil, S, et al. Early developmental outcomes in children following convulsive status epilepticus: a longitudinal study. Epilepsia. 2013;54(6):1012–19.Google Scholar

Raspall-Chaure, M, Chin, RF, Neville, BG, Scott, RC. Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol. 2006;5(9):769–79.Google Scholar

Sahin, M, Menache, CC, Holmes, GL, Riviello, JJ. Outcome of severe refractory status epilepticus in children. Epilepsia. 2001;42(11):1461–7.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

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.Google Scholar

Abend, NS, Topjian, AA, Williams, S. How much does it cost to identify a critically ill child experiencing electrographic seizures? J Clin Neurophysiol. 2015;32(3):257–64.CrossRef Google Scholar PubMed

Abend, NS, Dlugos, DJ, Hahn, CD, Hirsch, LJ, Herman, ST. Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists. Neurocrit Care. 2010;12(3):382–9.Google Scholar

Payne, ET, Hahn, CD. Continuous electroencephalography for seizures and status epilepticus. Curr Opin Pediatr. 2014;26(6):675–81.Google Scholar

Gutierrez-Colina, AM, Topjian, AA, Dlugos, DJ, Abend, NS. Electroencephalogram monitoring in critically ill children: indications and strategies. Pediatr Neurol. 2012;46(3):158–61.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.CrossRef Google Scholar PubMed

Herman, ST, Abend, NS, Bleck, TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol. 2015;32(2):96–108.Google Scholar

Pensirikul, AD, Beslow, LA, Kessler, SK, et al. Density spectral array for seizure identification in critically ill children. J Clin Neurophysiol. 2013;30(4):371–5.Google Scholar

Stewart, CP, Otsubo, H, Ochi, A, et al. Seizure identification in the ICU using quantitative EEG displays. Neurology. 2010;75(17):1501–8.Google Scholar

Shah, DK, Mackay, MT, Lavery, S, et al. Accuracy of bedside electroencephalographic monitoring in comparison with simultaneous continuous conventional electroencephalography for seizure detection in term infants. Pediatrics. 2008;121(6):1146–54.CrossRef Google Scholar PubMed

Shellhaas, RA, Chang, T, Tsuchida, T, et al. The American Clinical Neurophysiology Society’s Guideline on Continuous Electroencephalography Monitoring in Neonates. J Clin Neurophysiol. 2011;28(6):611–17.Google Scholar

Hirsch, LJ, LaRoche, SM, Gaspard, N, et al. American Clinical Neurophysiology Society’s Standardized Critical Care EEG Terminology: 2012 version. J Clin Neurophysiol. 2013;30(1):1–27.Google Scholar

Chong, DJ, Hirsch, LJ. Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol. 2005;22(2):79–91.CrossRef Google Scholar PubMed

Ronner, HE, Ponten, SC, Stam, CJ, Uitdehaag, BM. Inter-observer variability of the EEG diagnosis of seizures in comatose patients. Seizure. 2009;18(4):257–63.Google Scholar

Brenner, RP, Schaul, N. Periodic EEG patterns: classification, clinical correlation, and pathophysiology. J Clin Neurophysiol. 1990;7(2):249–67.Google Scholar PubMed

Garzon, E, Fernandes, RM, Sakamoto, AC. Serial EEG during human status epilepticus: evidence for PLED as an ictal pattern. Neurology. 2001;57(7):1175–83.CrossRef Google Scholar PubMed

Treiman, DM, Walton, NY, Kendrick, C. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res. 1990;5(1):49–60.Google Scholar

Yemisci, M, Gurer, G, Saygi, S, Ciger, A. Generalised periodic epileptiform discharges: clinical features, neuroradiological evaluation and prognosis in 37 adult patients. Seizure. 2003;12(7):465–72.Google Scholar

Garcia-Morales, I, Garcia, MT, Galan-Davila, L, et al. Periodic lateralized epileptiform discharges: etiology, clinical aspects, seizures, and evolution in 130 patients. J Clin Neurophysiol. 2002;19(2):172–7.Google Scholar

Brenner, RP. Is it status? Epilepsia. 2002;43 (Suppl 3):103–13.Google Scholar

Fushimi, M, Matsubuchi, N, Sekine, A, Shimizu, T. Benign bilateral independent periodic lateralized epileptiform discharges. Acta Neurol Scand. 2003;108(1):55–9.Google Scholar

Koren, JP, Herta, J, Pirker, S, et al. Rhythmic and periodic EEG patterns of “ictal-interictal uncertainty” in critically ill neurological patients. Clin Neurophysiol. 2016;127(2):1176–81.Google Scholar

Claassen, J. How, I treat patients with EEG patterns on the ictal-interictal continuum in the neuro ICU. Neurocrit Care. 2009;11(3):437–44.Google Scholar

Wilkes, R, Tasker, RC. Pediatric intensive care treatment of uncontrolled status epilepticus. Crit Care Clin. 2013;29(2):239–57.CrossRef Google Scholar PubMed

Glauser, T, Shinnar, S, Gloss, D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48–61.Google Scholar

Abend, NS, Loddenkemper, T. Pediatric status epilepticus management. Curr Opin Pediatr. 2014;26(6):668–74.Google Scholar

Chin, RF, Neville, BG, Peckham, C, et al. Wade, A, Bedford, H, Scott, RC. Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol. 2008;7(8):696–703.Google Scholar

Alldredge, BK, Gelb, AM, Isaacs, SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345(9):631–7.Google Scholar

Appleton, R, Macleod, S, Martland, T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev. 2008(3):CD001905.Google Scholar

Sathe, AG, Tillman, H, Coles, LD, et al. Underdosing of benzodiazepines in patients with status epilepticus enrolled in established status epilepticus treatment trial. Acad Emerg Med. 2019;26(8):940–3.Google Scholar

Chin, RF, Verhulst, L, Neville, BG, Peters, MJ, Scott, RC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psychiatry. 2004;75(11):1584–8.Google Scholar

Chamberlain, JM, Kapur, J, Shinnar, S, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. Lancet. 2020;395(10231):1217–24.Google Scholar

Dalziel, SR, Borland, ML, Furyk, J, et al. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. Lancet. 2019;393(10186):2125–34.Google Scholar

Lyttle, MD, Rainford, NEA, Gamble, C, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet. 2019; 393(10186):2135–45.Google Scholar

Agarwal, P, Kumar, N, Chandra, R, et al. Randomized study of intravenous valproate and phenytoin in status epilepticus. Seizure. 2007;16(6):527–32.Google Scholar

Malamiri, RA, Ghaempanah, M, Khosroshahi, N, et al. Efficacy and safety of intravenous sodium valproate versus phenobarbital in controlling convulsive status epilepticus and acute prolonged convulsive seizures in children: a randomised trial. Eur J Paediatr Neurol. 2012;16(5):536–41.Google Scholar

Alvarez, V, Januel, JM, Burnand, B, Rossetti, AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011;52(7):1292–6.Google Scholar

Misra, UK, Kalita, J, Patel, R. Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology. 2006;67(2):340–2.Google Scholar

Goodkin, HP, Yeh, JL, Kapur, J. Status epilepticus increases the intracellular accumulation of GABAA receptors. J Neurosci. 2005;25(23):5511–20.CrossRef Google Scholar PubMed

Naylor, DE, Liu, H, Wasterlain, CG. Trafficking of GABA(A) receptors, loss of inhibition, and a mechanism for pharmacoresistance in status epilepticus. J Neurosci. 2005;25(34):7724–33.Google Scholar

Naylor, DE, Liu, H, Niquet, J, Wasterlain, CG. Rapid surface accumulation of NMDA receptors increases glutamatergic excitation during status epilepticus. Neurobiol Dis. 2013;54:225–38.Google Scholar

Mazarati, AM, Baldwin, RA, Sankar, R, Wasterlain, CG. Time-dependent decrease in the effectiveness of antiepileptic drugs during the course of self-sustaining status epilepticus. Brain Res. 1998;814(1–2):179–85.CrossRef Google Scholar PubMed

Goodkin, HP, Liu, X, Holmes, GL. Diazepam terminates brief but not prolonged seizures in young, naive rats. Epilepsia. 2003;44(8):1109–12.Google Scholar

Eriksson, K, Kalviainen, R. Pharmacologic management of convulsive status epilepticus in childhood. Expert Rev Neurother. 2005;5(6):777–83.Google Scholar

DeLorenzo, RJ, Garnett, LK, Towne, AR, et al. Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Epilepsia. 1999;40(2):164–9.Google Scholar

Logroscino, G, Hesdorffer, DC, Cascino, GD, et al. Long-term mortality after a first episode of status epilepticus. Neurology. 2002;58(4):537–41.Google Scholar

Sanchez Fernandez, I, Gainza-Lein, M, Abend, NS, et al. Factors associated with treatment delays in pediatric refractory convulsive status epilepticus. Neurology. 2018;90(19):e1692-e701.Google Scholar

Lowenstein, DH, Alldredge, BK. Status epilepticus at an urban public hospital in the 1980s. Neurology. 1993; 43 (3 Pt 1): 483–8.Google Scholar

Sutter, R, Kaplan, PW, Ruegg, S. Outcome predictors for status epilepticus–what really counts. Nat Rev Neurol. 2013;9(9):525–34.Google Scholar

Sanchez Fernandez, I, Abend, NS, Agadi, S, et al. Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure. 2014;23(2):87–97.Google Scholar

Rossetti, AO, Lowenstein, DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011;10(10):922–30.Google Scholar

Koul, R, Chacko, A, Javed, H, Al Riyami, K. Eight-year study of childhood status epilepticus: midazolam infusion in management and outcome. J Child Neurol. 2002;17(12):908–10.Google Scholar

Lambrechtsen, FA, Buchhalter, JR. Aborted and refractory status epilepticus in children: a comparative analysis. Epilepsia. 2008;49(4):615–25.Google Scholar

Lewena, S, Pennington, V, Acworth, J, et al. Emergency management of pediatric convulsive status epilepticus: a multicenter study of 542 patients. Pediatr Emerg Care. 2009;25(2):83–7.Google Scholar

Zaw, W, Knoppert, DC, da Silva, O. Flumazenil’s reversal of myoclonic-like movements associated with midazolam in term newborns. Pharmacotherapy. 2001;21(5):642–6.Google Scholar

Meierkord, H, Boon, P, Engelsen, B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010;17(3):348–55.Google Scholar

Krishnamurthy, KB, Drislane, FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40(6):759–62.Google Scholar

Claassen, J, Hirsch, LJ, Emerson, RG, Mayer, SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43(2):146–53.Google Scholar

Kang, BS, Jung, KH, Shin, JW, et al. Induction of burst suppression or coma using intravenous anesthetics in refractory status epilepticus. J Clin Neurosci. 2015;22(5):854–8.Google Scholar

Hocker, SE, Britton, JW, Mandrekar, JN, Wijdicks, EF, Rabinstein, AA. Predictors of outcome in refractory status epilepticus. JAMA Neurol. 2013;70(1):72–7.CrossRef Google Scholar PubMed

Friedman, D, Claassen, J, Hirsch, LJ. Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg. 2009;109(2):506–23.CrossRef Google Scholar PubMed

Ferlisi, M, Shorvon, S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain. 2012;135(Pt 8):2314–28.Google Scholar

Gaspard, N, Foreman, B, Judd, LM, et al. Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study. Epilepsia. 2013;54(8):1498–503.Google Scholar

Nabbout, R, Mazzuca, M, Hubert, P, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia. 2010;51(10):2033–7.Google Scholar

Fung, EL, Chang, SK, Yam, KK, Yau, PY. Ketogenic diet as a therapeutic option in super-refractory status epilepticus. Pediatrics and Neonatol. 2015;56(6):429–31.CrossRef Google Scholar PubMed

Corry, JJ, Dhar, R, Murphy, T, Diringer, MN. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008;9(2):189–97.Google Scholar

Lin, JJ, Lin, KL, Hsia, SH, Wang, HS. Therapeutic hypothermia for febrile infection-related epilepsy syndrome in two patients. Pediatr Neurol. 2012;47(6):448–50.Google Scholar

Vendrame, M, Loddenkemper, T. Surgical treatment of refractory status epilepticus in children: candidate selection and outcome. Semin Pediatr Neurol. 2010;17(3):182–9.Google Scholar

Greiner, HM, Tillema, JM, Hallinan, BE, et al. Corpus callosotomy for treatment of pediatric refractory status epilepticus. Seizure. 2012;21(4):307–9.Google Scholar

Petit-Pedrol, M, Armangue, T, Peng, X, et al. Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABAA receptor: a case series, characterisation of the antigen, and analysis of the effects of antibodies. Lancet Neurol. 2014;13(3):276–86.Google Scholar

Suleiman, J, Brilot, F, Lang, B, Vincent, A, Dale, RC. Autoimmune epilepsy in children: case series and proposed guidelines for identification. Epilepsia. 2013;54(6):1036–45.Google Scholar

Abend, NS, Wusthoff, CJ, Goldberg, EM, Dlugos, DJ. Electrographic seizures and status epilepticus in critically ill children and neonates with encephalopathy. Lancet Neurol. 2013;12(12):1170–9.CrossRef Google Scholar PubMed

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