title: Treatment of electrographic seizures and status epilepticus in critically ill children: a single center experience.
abstract: OBJECTIVE
  Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in encephalopathic children in the pediatric intensive care unit (PICU) and associated with worse short-term outcome. Survey data indicate most physicians treat ES and ESE with antiepileptic drugs (AEDs), but few data are available regarding AED usage patterns. We aimed to describe AED usage for ES and ESE in critically ill children.
  
  
  METHODS
  We performed an observational study of patients who underwent continuous electroencephalographic (cEEG) monitoring in the PICU of a single quaternary care children's hospital. We collected data regarding age, clinical diagnoses, ES and ESE occurrence, and AEDs utilized.
  
  
  RESULTS
  200 subjects underwent cEEG. ES occurred in 21% (41/200) and ESE occurred in 22% (43/200). Of the 84 patients with ES or ESE, 80 received non-benzodiazepine AEDs including 48% (38 of 80) with ES and 52% (42 of 80) with ESE. The most commonly administered first AEDs were levetiracetam in 38% (30/80), phenobarbital in 31% (25/80), phenytoin-fosphenytoin in 28% (22/80), and valproate in 4% (3/80). Seizures terminated after administration of the first AED in 74% (28/38) with ES and 22% (9/41) with ESE.
  
  
  CONCLUSIONS
  Levetiracetam, phenobarbital, and phenytoin-fosphenytoin are commonly used to manage ES and ESE at our center. Over half of subjects received multiple AEDs.
authors.affiliation: Division of Neurology, The Perelman School of Medicine at the University of Pennsylvania, USA. abend@email.chop.edu
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Sanchez
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Dlugos
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D019370:Observation; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy*; D013226:Status Epilepticus / Q000188:drug therapy*
chemical_list: D000927:Anticonvulsants