Abstracts

Rationale: NCSE is heterogeneous disorder, defined as a condition of ongoing or intermittent seizure activity on EEG without clinical convulsions for at least 5 to 10 minutes, without recovery of consciousness between attacks (1, 2.) NCSE remains a challenging diagnosis for pediatric intensivist and neurologists. We aimed to review all EEG-confirmed pediatric cases with NCSE in the PICU, to see if there are predictive factors or unique guiding features. Methods: This is a retrospective review of medical records and EEG recordings on children suspected to have NCSE in the pediatric intensive care unit (PICU). The age ranged from 1 day- to 14-years. All patients were evaluated by Pediatric Neurology Service with suspicion of NCSE. The study was done in children admitted to, King Faisal Specialist Hospital and Research Center in Riyadh, during the period of January 2000 to January of 2015. The demographic, clinical, Neuro-imaging, and Neurophysiology data was collected and analyzed in these patients. The EEG recordings were reviewed by co-authors to confirm reported data. Results: A total of 540 EEG's were recorded in the PICU from Jan 2000- Jan 2015 for various reasons, out of these 250 EEG's were recorded on patients with suspected NCSE (by EEG referral request). Out of these there were 17 children with EEG-confirmed NCSE, 7 %. 29% were less than 3 months old (n=5), 23% between 3-12 months old (n=4). 29% were between 1-5 yrs. (n=5) and 17.6 % were between 5-14 yrs. (n=3). Girls were 52.9% (n=9). 12 EEG records were routine (20 minute duration) and 5 were prolonged recordings 1-2 hours of saved EEG clips of Long term monitoring. Developmental delay was found in 52.9% of children with NCSE (n=9) including 1 child with history of Developmental regression. 47% of children (n=8) with NCSE had no previous history of Seizures or Epilepsy, they were admitted to the PICU with varying diagnoses and systemic diseases. They were found to have acute mental status changes. Majority (75%) of them had associated motor phenomena (table 1). 9 children (52.9%) had previous history of epilepsy, with status epilepticus reported in only 5.8%. 2 patients were on single anti epileptic drug (AED), 7 were on two or more AEDs with fair seizure control. Most of them 66 % had multiple acute/ sub-acute systemic metabolic derangement as a preceding factor. For details on EEG and clinical findings on our cohort, see table 1. Generalized EEG seizures were uniquely rare in our cohort and a normal background was rare (2/17). Figure 1, shows the outcome of the group with prior epilepsy versus the no prior epilepsy group. The outcome was dichotomized into either worsened clinical condition or death and improved or stable condition. Conclusions: 1. NCSE in the PICU- should be suspected in patients regardless of prior history of seizures or Epilepsy. 2. Most presumed NCSE have associated subtle motor phenomena that can be easily overlooked. 3. No specific signature EEG findings are diagnostic of NCSE; however a routine recording in a child with altered level of consciousness may be sufficient to verify the possibility of NCSE. 4. Regardless of previous epilepsy history the outcome is generally worse in two-third of the pediatric NCSE cases in our cohort. References: 1. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17:3. 2. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56:1515. Funding: none.