title: Nonconvulsive status epilepticus: the encephalopathic pediatric patient.
abstract: OBJECTIVE
  A high prevalence of nonconvulsive status epilepticus (NCSE) has been reported in critically ill adults and neonates. Recent prospective pediatric studies focus on critically ill children and show wide variability in the frequency of NCSE. This study examines prevalence of pediatric NCSE regardless of inpatient setting and retrospectively identifies risk factors indicating a need for urgent continuous EEG.
  
  
  METHODS
  Medical records from patients aged 3 months to 21 years were identified either by (1) searching a clinical EEG database (n = 18) or (2) consecutive inpatient EEG referrals for NCSE over an 8-month period (n = 57).
  
  
  RESULTS
  Seventy-five children, mean age of 7.8 years, were studied. NCSE was identified in 26 patients (35%) and in 8 of 57 (14%) patients referred for possible NCSE. More than half of the patients referred were outside of the ICU. A witnessed clinical seizure was observed in 24 of 26 (92%) patients with NCSE. Acute cortical neuroimaging abnormalities were significantly more frequent in patients with NCSE. The presence of clinical seizures and acute neuroimaging abnormality was associated with an 82% probability of NCSE. All but 1 patient with NCSE had electrographic or electroclinical seizures within the first hour of monitoring.
  
  
  CONCLUSIONS
  A high prevalence of NCSE was observed, comparable to adult studies, but within a wider range of inpatient settings. Children with acute encephalopathy should undergo continuous EEG. This evaluation is more urgent if certain clinical risk factors are present. Optimal duration of monitoring and the effect of NCSE on prognosis should be studied.
authors.affiliation: Division of Child Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. hansel.greiner@cchmc.org
authors.forename: Hansel M
authors.initials: HM
authors.lastname: Greiner
authors.forename: Katherine
authors.initials: K
authors.lastname: Holland
authors.forename: James L
authors.initials: JL
authors.lastname: Leach
authors.forename: Paul S
authors.initials: PS
authors.lastname: Horn
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Hershey
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Rose
mesh_terms: D000328:Adult; D017677:Age Distribution; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants