title: The prevalence of seizures in comatose children in the pediatric intensive care unit: a prospective video-EEG study.
abstract: OBJECTIVE
  Studies in adult and neonatal intensive care units (ICUs) report a high prevalence of epileptic seizures in comatose patients. The prevalence of seizures in pediatric ICUs is variably reported in a few retrospective studies using different electroencephalography (EEG) methods. We aimed to determine prospectively the prevalence of epileptic seizures (clinical and subclinical) in comatose children in the pediatric ICU using continuous video-EEG (v-EEG) monitoring.
  
  
  METHODS
  We performed v-EEG in consecutive children aged 2 months to 17 years admitted to the pediatric ICU with sustained depressed consciousness over a period of 15 months.
  
  
  RESULTS
  We monitored 100 comatose children, 69% within 24 h of ICU admission. Median length of ICU stay was 5 days. Median duration of v-EEG was 20 h. Epileptic seizures were identified in only seven patients, of whom six had a history of epilepsy with witnessed seizures immediately prior to v-EEG. All epileptic seizures were recorded in the first 3 h of v-EEG. Seizures were suspected by ICU staff in 18 monitored patients, only four of whom had confirmed epileptic seizures.
  
  
  CONCLUSIONS
  The lower prevalence of epileptic seizures and the shorter length of ICU stay in children compared to adults and neonates suggest a different spectrum of disease and neurologic response. Short-duration v-EEG in patients with a history of prior seizures, epilepsy, or clinical events suspected to be seizures seems more appropriate than routine v-EEG in all comatose children in the pediatric ICU.
authors.affiliation: Children's Neuroscience Centre, The Royal Children's Hospital, Melbourne, Vic, Australia. amre_s@yahoo.com
authors.forename: Amre
authors.initials: A
authors.lastname: Shahwan
authors.forename: Catherine
authors.initials: C
authors.lastname: Bailey
authors.forename: Lara
authors.initials: L
authors.lastname: Shekerdemian
authors.forename: A Simon
authors.initials: AS
authors.lastname: Harvey
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D014743:Videotape Recording / Q000379:methods