Abstracts

Rationale: Several studies indicate a higher occurrence of seizures in intensive care unit patients, many of which are not clinically apparent. Few of these studies are devoted exclusively to pediatric patients. The purpose of this study is to determine the occurrence of seizures in a cohort of pediatric and neonatal intensive care unit patients. Methods: Long-term video EEG monitoring studies performed in the pediatric and neonatal intensive care units were reviewed. Age, gender, diagnosis, EEG background, epileptiform activity, time of onset and duration of seizures, presence of clinical or subclinical seizures, and survival were collected. Results: One hundred thirty-eight recordings encompassing 122 patients were identified. Thirty-four percent of the sessions identified seizures in the first 24 hours: 17% captured electroclinical seizures, 49% were electrographic only, and 34% had both electroclinical and electrographic seizures. Most (70%) of the first seizures occurred within the first hour of recording, but 30% did not. Younger age, epileptiform activity, and periodic discharges were associated with the occurrence of seizures. Diagnoses of head trauma and status epilepticus/recent prior seizure were more likely than other at-risk diagnoses to be associated with seizures; cardiac arrest managed with hypothermia was least likely to be associated with seizures. A quarter of the studies identified non-epileptic events. Conclusions: Seizures occurred in nearly a third of critically ill pediatric patients undergoing EEG monitoring, and many of these seizures did not have a behavioral correlate. In those at risk for seizures in intensive care units, there should be a low threshold for obtaining long-term monitoring.