Abstracts

Rationale: Seizures are common in critically ill children. In these children, presence of seizures and/or status epilepticus (SE) is associated with worse outcome. In repeated seizures or SE, treatment with first and second line antiepileptic drugs (AED) is well established. Refractory SE is defined as seizures resistant to treatment with first and second line AED; intravenous anesthetic drugs (IVAD) are the usual choice of treatment. The effect of treatment with AED and IVAD on outcome is unclear.  Methods: We retrospectively studied children admitted to the pediatric intensive care unit (PICU) due to recurrent seizures or SE, and treated with first, second and third line drugs. All children were submitted to continuous EEG (cEEG) monitoring. Medical reports and cEEG recordings were reviewed. We collected the following clinical data: level of consciousness on admission (divided into alert, drowsy, stupor and coma), seizures/SE etiology (acute systemic, acute neurological, and undefined), occurrence of seizures during hospitalization, neurodevelopmental status, history of epilepsy, and neuroimaging findings (acute or chronic structural lesion, or normal). Use of first, second and third line (IVAD) drugs was noted. Primary outcome was classified in better, worse (including death) and unchanged, when compared to admission. Secondary outcome measures were: use of mechanical ventilation and length of stay (both at the PICU and the hospital). Results: One hundred admissions of 80 children (age 0.08-17 years, 61.3% male) were analyzed. 95% received first line, 66% second line and 30% third line medications. 73% were classified as unchanged outcome, 4% better and 19% worse; 4% died. Altered mental status on admission was associated with worse outcome, with an odds ratio of 2.2 for each additional level of alteration of consciousness. 41% had an acute systemic and 12% an acute neurological cause for seizures/SE; in 47% cause was undefined. Acute neurological causes were associated with worse outcome. Occurrence of seizures during hospitalization was associated with worse outcome (94% had seizures) and death  (100% with seizures). Neurodevelopmental delay was associated with better or unchanged outcome (p=0.01). 70% had previous history of epilepsy, which was associated with outcomes better and unchanged (p<0.001). Use of IVAD was associated with worse outcome (p=0.001). Both increased length of stay at the hospital and use of mechanical ventilation were associated with acute structural lesion on neuroimaging, alteration of consciousness and use of IVAD. On multivariate analysis, use of IVAD increased in 13.79 times the need for mechanical ventilation. Conclusions: Outcome of critically ill children with seizures and SE is variable in different studies, depending on population characteristics, etiology of seizures and treatment, among other features. In our series, altered mental status on admission, acute neurological causes for seizures/SE and use of IVAD were associated with worse outcome on discharge. Funding: No funding