title: Electrographic status epilepticus and long-term outcome in critically ill children.
abstract: OBJECTIVE
  Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in children in the pediatric intensive care unit (PICU) with acute neurologic conditions. We aimed to determine whether ES or ESE was associated with worse long-term outcomes.
  
  
  METHODS
  Three hundred children with an acute neurologic condition and encephalopathy underwent clinically indicated EEG monitoring and were enrolled in a prospective observational study. We aimed to obtain follow-up data from 137 subjects who were neurodevelopmentally normal before PICU admission.
  
  
  RESULTS
  Follow-up data were collected for 60 of 137 subjects (44%) at a median of 2.7 years. Subjects with and without follow-up data were similar in clinical characteristics during the PICU admission. Among subjects with follow-up data, ES occurred in 12 subjects (20%) and ESE occurred in 14 subjects (23%). Multivariable analysis indicated that ESE was associated with an increased risk of unfavorable Glasgow Outcome Scale (Extended Pediatric Version) category (odds ratio 6.36, p = 0.01) and lower Pediatric Quality of Life Inventory scores (23 points lower, p = 0.001). Among subjects without prior epilepsy diagnoses ESE was associated with an increased risk of subsequently diagnosed epilepsy (odds ratio 13.3, p = 0.002). ES were not associated with worse outcomes.
  
  
  CONCLUSIONS
  Among children with acute neurologic disorders who were reported to be neurodevelopmentally normal before PICU admission, ESE but not ES was associated with an increased risk of unfavorable global outcome, lower health-related quality of life scores, and an increased risk of subsequently diagnosed epilepsy even after adjusting for neurologic disorder category, EEG background category, and age.
authors.affiliation: From the Department of Anesthesia and Critical Care Medicine (R.A.B., A.A.T.), The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Division of Neurology (K.L.W., S.M.S., D.J.D., N.S.A.), The Children's Hospital of Philadelphia; Departments of Neurology and Pediatrics (D.J.D., N.S.A.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Psychology Department (T.P.B., M.T.S.), Drexel University, Philadelphia, PA; and Department of Pediatrics (J.R.), Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, PA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wagenman
authors.forename: Taylor P
authors.initials: TP
authors.lastname: Blake
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Sanchez
authors.forename: Maria T
authors.initials: MT
authors.lastname: Schultheis
authors.forename: Jerilynn
authors.initials: J
authors.lastname: Radcliffe
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
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004569:Electroencephalography / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013226:Status Epilepticus / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome