Abstracts

Rationale: Continuous-Video EEG Monitoring (CVEEG) monitoring is commonly used to manage medically refractory status epilepticus in the intensive care unit. However, many other critically ill patients experience seizures, many of which are not appreciable without the use of CVEEG. We wished to characterize seizures in critically ill patients in a tertiary care pediatric hospital. Methods: Patients who underwent CVEEG in the pediatric intensive care unit at Phoenix Children’s Hospital from October 2006 to May 2008 (excluding those who underwent intracranial grid placement) were identified. The following data were collected: gender, age, admitting diagnosis, reason for CVEEG, duration of recording, presence of seizures (electroclinical or electrographic), duration of seizures, frequency of seizures, length of seizures, presence of periodic discharges, and outcome. Results: Sixty-one patients were identified, constituting 65 unique monitoring sessions. Fifty-five percent were male. Ages ranged from 7 days to 17 years. Typical admission diagnoses were status epilepticus, traumatic brain injury, meningitis, intracranial hemorrhage, and prolonged cardiac arrest. CVEEG was obtained for: status epilepticus management (12%); paroxysmal spell characterization (37%); hypothermia protocol (18%); encephalopathy (14%); neurophysiological monitoring (18%). Eighty-percent of sessions were less than 48 hours. Seizures were seen in 25 of 65 (38%) monitoring sessions: 80% of these sessions contained electrographic seizures, and 44% had electroclinical seizures, Forty-three percent of the sessions identified non-epileptic events. Fifty-six percent of patients with seizures had more than 10 seizures per 24 hours. Sixty percent of the sessions containing seizures had durations less than 5 minutes. Ten of the 65 sessions contained spontaneous or stimulus-induced periodic epileptiform discharges. Twenty-five percent expired either acutely or were discharged to hospice, and 17% developed new neurological deficits. Conclusions: Many critically ill patients experience seizures, the majority of which were not appreciable by bedside examination. These findings are similar to other reports in both children and adults monitored for different reasons. These results suggest the need for more aggressive continuous monitoring of critically ill patients; however, the utility of treating electrographic seizures and the prognostic information provided by these findings need further investigation.