title: Nonconvulsive seizures are common in critically ill children.
abstract: BACKGROUND
  Retrospective studies have reported the occurrence of nonconvulsive seizures in critically ill children. We aimed to prospectively determine the incidence and risk factors of nonconvulsive seizures in critically ill children using predetermined EEG monitoring indications and EEG interpretation terminology.
  
  
  METHODS
  Critically ill children (non-neonates) with acute encephalopathy underwent continuous EEG monitoring if they met institutional clinical practice criteria. Study enrollment and data collection were prospective. Logistic regression analysis was utilized to identify risk factors for seizure occurrence.
  
  
  RESULTS
  One hundred children were evaluated. Electrographic seizures occurred in 46 and electrographic status epilepticus occurred in 19. Seizures were exclusively nonconvulsive in 32. The only clinical risk factor for seizure occurrence was younger age (p=0.03). Of patients with seizures, only 52% had seizures detected in the first hour of monitoring, while 87% were detected within 24 hours.
  
  
  CONCLUSIONS
  Seizures were common in critically ill children with acute encephalopathy. Most were nonconvulsive. Clinical features had little predictive value for seizure occurrence. Further study is needed to confirm these data in independent high-risk populations, to clarify which children are at highest risk for seizures so limited monitoring resources can be allocated optimally, and to determine whether seizure detection and management improves outcome.
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA. abend@email.chop.edu
authors.forename: N S
authors.initials: NS
authors.lastname: Abend
authors.forename: A M
authors.initials: AM
authors.lastname: Gutierrez-Colina
authors.forename: A A
authors.initials: AA
authors.lastname: Topjian
authors.forename: H
authors.initials: H
authors.lastname: Zhao
authors.forename: R
authors.initials: R
authors.lastname: Guo
authors.forename: M
authors.initials: M
authors.lastname: Donnelly
authors.forename: R R
authors.initials: RR
authors.lastname: Clancy
authors.forename: D J
authors.initials: DJ
authors.lastname: Dlugos
mesh_terms: D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012640:Seizures / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D013226:Status Epilepticus / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors