title: Electrographic status epilepticus and neurobehavioral outcomes in critically ill children.
abstract: OBJECTIVE
  Electrographic seizures (ESs) and electrographic status epilepticus (ESE) are common in children with acute neurologic conditions in pediatric intensive care units (PICUs), and ESE is associated with worse functional and quality-of-life outcomes. As an exploratory study, we aimed to determine if ESE was associated with worse outcomes using more detailed neurobehavioral measures.
  
  
  METHODS
  Three hundred children with an acute neurologic condition and altered mental status underwent clinically indicated EEG monitoring and were enrolled in a prospective observational study. We obtained follow-up data from subjects who were neurodevelopmentally normal prior to PICU admission. We evaluated for associations between ESE and adaptive behavior (Adaptive Behavior Assessment System-II, ABAS-II), behavioral and emotional problems (Child Behavior Checklist, CBCL), and executive function (Behavior Rating Inventory of Executive Function, BRIEF) using linear regression analyses. A p-value of <0.05 was considered significant.
  
  
  RESULTS
  One hundred thirty-seven of 300 subjects were neurodevelopmentally normal prior to PICU admission. We obtained follow-up data from 36 subjects for the CBCL, 32 subjects for the ABAS-II, and 20 subjects for the BRIEF. The median duration from admission to follow-up was 2.6 years (IQR: 1.2-3.8). There were no differences in the acute care variables (age, sex, mental status category, intubation status, paralysis status, acute neurologic diagnosis category, seizure category, EEG background category, or short-term outcome) between subjects with and without follow-up data for any of the outcome measures. On univariate analysis, significant differences were not identified for CBCL total problem (ES coefficient: -4.1, p = 0.48; ESE coefficient: 8.9, p = 0.13) or BRIEF global executive function (ES coefficient: 2.1, p = 0.78; ESE coefficient: 14.1, p = 0.06) scores, although there were trends toward worse scores in subjects with ESE. On univariate analysis, ESs were not associated with worse scores (coefficient: -21.5, p = 0.051), while ESE (coefficient: -29.7, p = 0.013) was associated with worse ABAS-II adaptive behavioral global composite scores. On multivariate analysis, when compared to subjects with no seizures, both ESs (coefficient: -28, p=0.014) and ESE (coefficient: -36, p = 0.003) were associated with worse adaptive behavioral global composite scores.
  
  
  CONCLUSIONS
  Among previously neurodevelopmentally normal children with acute neurologic disorders, ESs and ESE were associated with worse adaptive behavior and trends toward worse behavioral-emotional and executive function problems. This was a small exploratory study, and the impact of ESs and ESE on these neurobehavioral measures may be clarified by subsequent larger studies. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: abend@email.chop.edu.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wagenman
authors.affiliation: Psychology Department, Drexel University, Philadelphia, PA, USA.
authors.forename: Taylor P
authors.initials: TP
authors.lastname: Blake
authors.affiliation: Psychology Department, Drexel University, Philadelphia, PA, USA.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Schultheis
authors.affiliation: Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Jerilynn
authors.initials: J
authors.lastname: Radcliffe
authors.affiliation: Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Dlugos
mesh_terms: D000342:Affective Symptoms / Q000209:etiology / Q000523:psychology; D002648:Child; D002652:Child Behavior; D002653:Child Behavior Disorders / Q000209:etiology / Q000523:psychology; D002675:Child, Preschool; D016638:Critical Illness; D016208:Databases, Factual; D004569:Electroencephalography; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology*; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012640:Seizures / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D013226:Status Epilepticus / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: EEG monitoring; Nonconvulsive seizure; Outcome; Pediatric; Seizure; Status epilepticus