title: Generalized periodic epileptiform discharges in critically ill children: clinical features, and outcome.
abstract: OBJECTIVE
  Generalized periodic epileptiform discharges (GPDs) are a specific periodic EEG pattern, reported as having a poor clinical outcome. The incidence and clinical implications of this EEG pattern in children are not known. In this study, we examined the clinical features of children with GPDs.
  
  
  METHODS
  EEG-video monitoring reports of children with critical illness in the intensive care unit were retrospectively reviewed to detect GPDs. The clinical history, hospital course and seizure characteristics were reviewed and outcome was based on the clinical findings at hospital discharge.
  
  
  RESULTS
  Twenty one children (age 2-18 years) were identified with GPDs. The most common underlying etiology was encephalitis (N=11). At the time of EEG, a continuous intravenous infusion (cIV) of an anticonvulsant drug was used to treat refractory status epilepticus (RSE). Non-convulsive seizures (NCS) were identified in 15, and clinical seizures in 13 children after GPDs were detected. GPDs occurred after a dose reduction in the cIV in 43%. Neuroimaging done in 16 children showed an acute change in 13/16 (81%) and chronic changes in 2/16 (13%). Five children (23%) died. Seven (33%) children had a favorable outcome, whereas the remaining children had a moderate to severe disability at the time of hospital discharge.
  
  
  CONCLUSIONS
  GPDs are seen during the course of RSE in critically ill children and are associated with seizure recurrence. A lower mortality rate occurs in children with GPDs compared to adult counterparts, likely related to different etiologies. Although the significance of GPDs must be determined within the context of the clinical situation, GPDs suggest a still active epileptic process.
authors: Department of Neurology, Division of Pediatric Neurology, Columbia University College of Physician & Surgeons, United States; Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine, United States; Department of Neurology, Kellaway Section of Neurophysiology, Baylor College of Medicine, United States. Electronic address: cia11@columbia.edu.
authors: Cigdem I
authors: CI
authors: Akman
authors: Karine J
authors: KJ
authors: Abou Khaled
authors: Eric
authors: E
authors: Segal
authors: Vesna
authors: V
authors: Micic
authors: James J
authors: JJ
authors: Riviello
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004185:Disability Evaluation; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000401:mortality; D007091:Image Processing, Computer-Assisted; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D013226:Status Epilepticus / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: Children; Continuous EEG monitoring; Critically ill; Generalized periodic epileptiform discharges