Monitoring Children for Seizures in the ICU

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In children with severe brain injuries, those with the highest risk for subclinical seizures are victims of abuse, children aged 2 or younger, and those with bleeding within the brain, according to a study presented at the American Epilepsy Society’s annual meeting.

In pediatric brain injury patients, risk of seizures can be predicted with “fair-to-good” accuracy based on clinical characteristics that are routinely recorded upon admission, reported Nicholas Abend, MD, of the Children’s Hospital of Philadelphia, and colleagues.

Detecting subclinical seizures in hospitalized children requires continuous EEG monitoring, and most centers don’t have the resources to perform such intense monitoring on all pediatric head trauma cases. Thus the researchers sought to help emergency care departments to track only the patients with the highest risk for seizures.

One of the studies included 135 consecutive pediatric patients with traumatic brain injuries who were treated in ICUs at the University of California Los Angeles and at the Children’s Hospital of Colorado in Denver. Each participant had continuous EEG monitoring to detect subclinical seizures.

In this first cohort, all subclinical seizures occurred in patients aged 2 or younger and in patients with intradural bleeding. The majority of these also involved abusive head trauma.

To validate these findings, a separate cohort of 44 pediatric patients with head injuries treated at the Children’s Hospital of Philadelphia was studied. Of the patients with subclinical seizures across both cohorts, 81% were victims of abusive head trauma (only 25% of all total patients had abusive head trauma).

A second study included 336 patients from 11 different centers tested against a separate dataset of 222 patients from the Children’s Hospital of Philadelphia. The researchers used clinical information to create a risk index score including: age, seizure etiology, presence of clinical seizures prior to beginning continuous EEG, initial EEG background category, and interictal discharge category.

The researchers designed their model so that different centers can adjust the sensitivity. A center with more resources can opt for a high sensitivity since they can treat more patients, while a hospital with fewer resources could lower the sensitivity to only monitor the most at-risk patients.

Child in ICU
Monitoring Children for Seizures in the ICU

Not all children with severe brain injuries need to be monitored for subclinical seizures, researchers said here, which means that resources can be focused on those at the highest risk.

Victims of abuse, those younger than 2, and those with bleeding within the brain rather than only in the epidural compartment are the pediatric ICU patients most likely to show significant seizure activity that should be detected and treated, said Rajsekar Rajaraman, MD, of the University of California Los Angeles (UCLA).

A separate study by many of the same investigators also found that, in a broader range of pediatric brain injury cases, risk of seizures could be predicted with "fair-to-good" accuracy on the basis of clinical characteristics that would be recorded routinely at admission.

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