title: Epileptic seizures in the pediatric intensive care unit setting.
abstract: OBJECTIVE
  The clinical features of seizures occurring in the pediatric intensive care unit (PICU) setting are not well characterized. Adult ICU studies reveal an incidence of seizures ranging from 0.8% to 3.3%, with vascular, metabolic abnormalities, and drug withdrawal being the most common etiologies. The objective of this study is to investigate the clinical characteristics of seizures in children admitted to the PICU at our institution.
  
  
  METHODS
  We performed a retrospective review of all patients with diagnoses of seizures or epilepsy, admitted to our PICU from 2002 to 2004. Of 6,820 admissions, 32 patients, aged one month to 19 years had seizures in the PICU.
  
  
  RESULTS
  The incidence of seizures was 0.5%. Developmental delay or mental retardation was present in 37% of patients. Seizures were generalized in 26 (81%), and focal in 6 (19%); 34% had status epilepticus. The etiology of seizures was epilepsy in 11 (34%). Seizures that do not meet the diagnosis of epilepsy were diagnosed in 21 (66%) including post-craniotomy in five (23%), febrile seizures in three (14%), encephalitis in three (14%), and hydrocephalus in three (14%). Thirty-one patients (97%) were initially treated with either lorazepam or fosphenytoin.
  
  
  CONCLUSIONS
  Seizures in PICU have different clinical characteristics from those in adults. Recognizing the common seizure etiologies in PICU is likely to lead to a more prompt and effective treatment. Antiepileptic drug prophylaxis may be useful in post-craniotomy patients. A neurological consultation and EEG evaluation are of the utmost importance to help rule in or out epileptic disorders in the PICU.
authors.affiliation: Section of Neurology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA 19134, USA. ignacio.valencia@drexelmed.edu
authors.forename: Ignacio
authors.initials: I
authors.lastname: Valencia
authors.forename: Germán
authors.initials: G
authors.lastname: Lozano
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Kothare
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Melvin
authors.forename: Divya S
authors.initials: DS
authors.lastname: Khurana
authors.forename: H Huntley
authors.initials: HH
authors.lastname: Hardison
authors.forename: Sabrina S
authors.initials: SS
authors.lastname: Yum
authors.forename: Agustín
authors.initials: A
authors.lastname: Legido
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male