Electrographic seizures after convulsive status epilepticus in children and young adults: A retrospective multicenter study

Iván Sánchez Fernández; Nicholas S. Abend; Daniel H. Arndt; Jessica L. Carpenter; Kevin E. Chapman; Karen M. Cornett; Dennis J. Dlugos; William B. Gallentine; Christopher C. Giza; Joshua L. Goldstein; Cecil D. Hahn; Jason T. Lerner; Joyce H. Matsumoto; Kristin McBain; Kendall B. Nash; Eric Payne; Sarah M. Sánchez; Korwyn Williams; Tobias Loddenkemper

doi:10.1016/j.jpeds.2013.09.032

Electrographic seizures after convulsive status epilepticus in children and young adults: A retrospective multicenter study

Iván Sánchez Fernández, Nicholas S. Abend^*, Daniel H. Arndt, Jessica L. Carpenter, Kevin E. Chapman, Karen M. Cornett, Dennis J. Dlugos, William B. Gallentine, Christopher C. Giza, Joshua L. Goldstein, Cecil D. Hahn, Jason T. Lerner, Joyce H. Matsumoto, Kristin McBain, Kendall B. Nash, Eric Payne, Sarah M. Sánchez, Korwyn Williams, Tobias Loddenkemper

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

48 Scopus citations

Abstract

Objective To describe the prevalence, characteristics, and predictors of electrographic seizures after convulsive status epilepticus (CSE). Study design This was a multicenter retrospective study in which we describe clinical and electroencephalographic (EEG) features of children (1 month to 21 years) with CSE who underwent continuous EEG monitoring. Results Ninety-eight children (53 males) with CSE (median age of 5 years) underwent subsequent continuous EEG monitoring after CSE. Electrographic seizures (with or without clinical correlate) were identified in 32 subjects (33%). Eleven subjects (34.4%) had electrographic-only seizures, 17 subjects (53.1%) had electroclinical seizures, and 4 subjects (12.5%) had an unknown clinical correlate. Of the 32 subjects with electrographic seizures, 15 subjects (46.9%) had electrographic status epilepticus. Factors associated with the occurrence of electrographic seizures after CSE were a previous diagnosis of epilepsy (P =.029) and the presence of interictal epileptiform discharges (P <.0005). The median (p ₂₅-p₇₅) duration of stay in the pediatric intensive care unit was longer for children with electrographic seizures than for children without electrographic seizures (9.5 [3-22.5] vs 2 [2-5] days, Wilcoxon test, Z = 3.916, P =.0001). Four children (4.1%) died before leaving the hospital, and we could not identify a relationship between death and the presence or absence of electrographic seizures. Conclusions After CSE, one-third of children who underwent EEG monitoring experienced electrographic seizures, and among these, one-third experienced entirely electrographic-only seizures. A previous diagnosis of epilepsy and the presence of interictal epileptiform discharges were risk factors for electrographic seizures.

Original language	English (US)
Pages (from-to)	339-346.e2
Journal	journal of pediatrics
Volume	164
Issue number	2
DOIs	https://doi.org/10.1016/j.jpeds.2013.09.032
State	Published - Feb 2014

Funding

I.S.F is funded by a grant for the study of Epileptic Encephalopathies from “Fundación Alfonso Martín Escudero.” N.A. is funded by the National Institutes of Health (NIH; K23NS076550) and the Children's Hospital of Philadelphia Department of Pediatrics and receives royalties from Demos Medical Publishing. D.A. is on the speaker's bureau for Cyberonics. D.D. is funded by NIH (1R01NS053998, 2U01NS045911, 1R01LM011124, and U01NS077276), and has also given expert testimony in medico-legal cases. C.G. is supported by National Institute of Neurological Disorders and Stroke (NINDS), Thrasher Research Foundation, Child Neurology Foundation/Winokur Family Foundation, Today's and Tomorrow's Children's Fund, University of California, Los Angeles, Grants Program, and National Football League Charities. C.H. receives research funding from the Canadian Institutes of Health Research, the Physician Services Incorporated Foundation, and the SickKids Foundation. T.L. serves on the Laboratory Accreditation Board for Long Term (Epilepsy and ICU) Monitoring; serves as a member of the American Clinical Neurophysiology Council; serves on the American Board of Clinical Neurophysiology, serves as an Associate Editor for Seizure (the European Journal of Epilepsy); performs and receives payments for video EEG long-term monitoring, EEGs, and other electrophysiological studies at Boston Children's Hospital; receives support from NIH/NINDS (1R21NS076859-01 [2011-2013]); is supported by a Career Development Fellowship Award from Harvard Medical School and Boston Children's Hospital, by the Program for Quality and Safety at Boston Children's Hospital, and by the Payer Provider Quality Initiative; receives funding from the Epilepsy Foundation of America (EF-213583 and EF-213882), from the Center for Integration of Medicine & Innovative Technology, the Translational Research Project at Boston Children's Hospital, the Epilepsy Therapy Project; received an Infrastructure Award from American Epilepsy Society, Cure; and received investigator initiated research support from Eisai Inc and Lundbeck. The other authors declare no conflicts of interest. The sponsors did not participate in study design, data collection, analysis and interpretation, writing of the manuscript, or the decision to submit the manuscript for publication.

Keywords

CSE
Convulsive status epilepticus
EEG
Electroencephalogram

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

Access to Document

10.1016/j.jpeds.2013.09.032

Cite this

Sánchez Fernández, I., Abend, N. S., Arndt, D. H., Carpenter, J. L., Chapman, K. E., Cornett, K. M., Dlugos, D. J., Gallentine, W. B., Giza, C. C., Goldstein, J. L., Hahn, C. D., Lerner, J. T., Matsumoto, J. H., McBain, K., Nash, K. B., Payne, E., Sánchez, S. M., Williams, K., & Loddenkemper, T. (2014). Electrographic seizures after convulsive status epilepticus in children and young adults: A retrospective multicenter study. journal of pediatrics, 164(2), 339-346.e2. https://doi.org/10.1016/j.jpeds.2013.09.032

@article{56949ac0ac184600bbff646197653cd7,

title = "Electrographic seizures after convulsive status epilepticus in children and young adults: A retrospective multicenter study",

abstract = "Objective To describe the prevalence, characteristics, and predictors of electrographic seizures after convulsive status epilepticus (CSE). Study design This was a multicenter retrospective study in which we describe clinical and electroencephalographic (EEG) features of children (1 month to 21 years) with CSE who underwent continuous EEG monitoring. Results Ninety-eight children (53 males) with CSE (median age of 5 years) underwent subsequent continuous EEG monitoring after CSE. Electrographic seizures (with or without clinical correlate) were identified in 32 subjects (33%). Eleven subjects (34.4%) had electrographic-only seizures, 17 subjects (53.1%) had electroclinical seizures, and 4 subjects (12.5%) had an unknown clinical correlate. Of the 32 subjects with electrographic seizures, 15 subjects (46.9%) had electrographic status epilepticus. Factors associated with the occurrence of electrographic seizures after CSE were a previous diagnosis of epilepsy (P =.029) and the presence of interictal epileptiform discharges (P <.0005). The median (p 25-p75) duration of stay in the pediatric intensive care unit was longer for children with electrographic seizures than for children without electrographic seizures (9.5 [3-22.5] vs 2 [2-5] days, Wilcoxon test, Z = 3.916, P =.0001). Four children (4.1%) died before leaving the hospital, and we could not identify a relationship between death and the presence or absence of electrographic seizures. Conclusions After CSE, one-third of children who underwent EEG monitoring experienced electrographic seizures, and among these, one-third experienced entirely electrographic-only seizures. A previous diagnosis of epilepsy and the presence of interictal epileptiform discharges were risk factors for electrographic seizures.",

keywords = "CSE, Convulsive status epilepticus, EEG, Electroencephalogram",

author = "{S{\'a}nchez Fern{\'a}ndez}, Iv{\'a}n and Abend, {Nicholas S.} and Arndt, {Daniel H.} and Carpenter, {Jessica L.} and Chapman, {Kevin E.} and Cornett, {Karen M.} and Dlugos, {Dennis J.} and Gallentine, {William B.} and Giza, {Christopher C.} and Goldstein, {Joshua L.} and Hahn, {Cecil D.} and Lerner, {Jason T.} and Matsumoto, {Joyce H.} and Kristin McBain and Nash, {Kendall B.} and Eric Payne and S{\'a}nchez, {Sarah M.} and Korwyn Williams and Tobias Loddenkemper",

note = "Funding Information: I.S.F is funded by a grant for the study of Epileptic Encephalopathies from “Fundaci{\'o}n Alfonso Mart{\'i}n Escudero.” N.A. is funded by the National Institutes of Health (NIH; K23NS076550) and the Children's Hospital of Philadelphia Department of Pediatrics and receives royalties from Demos Medical Publishing. D.A. is on the speaker's bureau for Cyberonics. D.D. is funded by NIH (1R01NS053998, 2U01NS045911, 1R01LM011124, and U01NS077276), and has also given expert testimony in medico-legal cases. C.G. is supported by National Institute of Neurological Disorders and Stroke (NINDS), Thrasher Research Foundation, Child Neurology Foundation/Winokur Family Foundation, Today's and Tomorrow's Children's Fund, University of California, Los Angeles, Grants Program, and National Football League Charities. C.H. receives research funding from the Canadian Institutes of Health Research, the Physician Services Incorporated Foundation, and the SickKids Foundation. T.L. serves on the Laboratory Accreditation Board for Long Term (Epilepsy and ICU) Monitoring; serves as a member of the American Clinical Neurophysiology Council; serves on the American Board of Clinical Neurophysiology, serves as an Associate Editor for Seizure (the European Journal of Epilepsy); performs and receives payments for video EEG long-term monitoring, EEGs, and other electrophysiological studies at Boston Children's Hospital; receives support from NIH/NINDS (1R21NS076859-01 [2011-2013]); is supported by a Career Development Fellowship Award from Harvard Medical School and Boston Children's Hospital, by the Program for Quality and Safety at Boston Children's Hospital, and by the Payer Provider Quality Initiative; receives funding from the Epilepsy Foundation of America (EF-213583 and EF-213882), from the Center for Integration of Medicine & Innovative Technology, the Translational Research Project at Boston Children's Hospital, the Epilepsy Therapy Project; received an Infrastructure Award from American Epilepsy Society, Cure; and received investigator initiated research support from Eisai Inc and Lundbeck. The other authors declare no conflicts of interest. The sponsors did not participate in study design, data collection, analysis and interpretation, writing of the manuscript, or the decision to submit the manuscript for publication.",

year = "2014",

month = feb,

doi = "10.1016/j.jpeds.2013.09.032",

language = "English (US)",

volume = "164",

pages = "339--346.e2",

journal = "journal of pediatrics",

issn = "0022-3476",

publisher = "Mosby Inc.",

number = "2",

}

Sánchez Fernández, I, Abend, NS, Arndt, DH, Carpenter, JL, Chapman, KE, Cornett, KM, Dlugos, DJ, Gallentine, WB, Giza, CC, Goldstein, JL, Hahn, CD, Lerner, JT, Matsumoto, JH, McBain, K, Nash, KB, Payne, E, Sánchez, SM, Williams, K & Loddenkemper, T 2014, 'Electrographic seizures after convulsive status epilepticus in children and young adults: A retrospective multicenter study', journal of pediatrics, vol. 164, no. 2, pp. 339-346.e2. https://doi.org/10.1016/j.jpeds.2013.09.032

TY - JOUR

T1 - Electrographic seizures after convulsive status epilepticus in children and young adults

T2 - A retrospective multicenter study

AU - Sánchez Fernández, Iván

AU - Abend, Nicholas S.

AU - Arndt, Daniel H.

AU - Carpenter, Jessica L.

AU - Chapman, Kevin E.

AU - Cornett, Karen M.

AU - Dlugos, Dennis J.

AU - Gallentine, William B.

AU - Giza, Christopher C.

AU - Goldstein, Joshua L.

AU - Hahn, Cecil D.

AU - Lerner, Jason T.

AU - Matsumoto, Joyce H.

AU - McBain, Kristin

AU - Nash, Kendall B.

AU - Payne, Eric

AU - Sánchez, Sarah M.

AU - Williams, Korwyn

AU - Loddenkemper, Tobias

N1 - Funding Information: I.S.F is funded by a grant for the study of Epileptic Encephalopathies from “Fundación Alfonso Martín Escudero.” N.A. is funded by the National Institutes of Health (NIH; K23NS076550) and the Children's Hospital of Philadelphia Department of Pediatrics and receives royalties from Demos Medical Publishing. D.A. is on the speaker's bureau for Cyberonics. D.D. is funded by NIH (1R01NS053998, 2U01NS045911, 1R01LM011124, and U01NS077276), and has also given expert testimony in medico-legal cases. C.G. is supported by National Institute of Neurological Disorders and Stroke (NINDS), Thrasher Research Foundation, Child Neurology Foundation/Winokur Family Foundation, Today's and Tomorrow's Children's Fund, University of California, Los Angeles, Grants Program, and National Football League Charities. C.H. receives research funding from the Canadian Institutes of Health Research, the Physician Services Incorporated Foundation, and the SickKids Foundation. T.L. serves on the Laboratory Accreditation Board for Long Term (Epilepsy and ICU) Monitoring; serves as a member of the American Clinical Neurophysiology Council; serves on the American Board of Clinical Neurophysiology, serves as an Associate Editor for Seizure (the European Journal of Epilepsy); performs and receives payments for video EEG long-term monitoring, EEGs, and other electrophysiological studies at Boston Children's Hospital; receives support from NIH/NINDS (1R21NS076859-01 [2011-2013]); is supported by a Career Development Fellowship Award from Harvard Medical School and Boston Children's Hospital, by the Program for Quality and Safety at Boston Children's Hospital, and by the Payer Provider Quality Initiative; receives funding from the Epilepsy Foundation of America (EF-213583 and EF-213882), from the Center for Integration of Medicine & Innovative Technology, the Translational Research Project at Boston Children's Hospital, the Epilepsy Therapy Project; received an Infrastructure Award from American Epilepsy Society, Cure; and received investigator initiated research support from Eisai Inc and Lundbeck. The other authors declare no conflicts of interest. The sponsors did not participate in study design, data collection, analysis and interpretation, writing of the manuscript, or the decision to submit the manuscript for publication.

PY - 2014/2

Y1 - 2014/2

N2 - Objective To describe the prevalence, characteristics, and predictors of electrographic seizures after convulsive status epilepticus (CSE). Study design This was a multicenter retrospective study in which we describe clinical and electroencephalographic (EEG) features of children (1 month to 21 years) with CSE who underwent continuous EEG monitoring. Results Ninety-eight children (53 males) with CSE (median age of 5 years) underwent subsequent continuous EEG monitoring after CSE. Electrographic seizures (with or without clinical correlate) were identified in 32 subjects (33%). Eleven subjects (34.4%) had electrographic-only seizures, 17 subjects (53.1%) had electroclinical seizures, and 4 subjects (12.5%) had an unknown clinical correlate. Of the 32 subjects with electrographic seizures, 15 subjects (46.9%) had electrographic status epilepticus. Factors associated with the occurrence of electrographic seizures after CSE were a previous diagnosis of epilepsy (P =.029) and the presence of interictal epileptiform discharges (P <.0005). The median (p 25-p75) duration of stay in the pediatric intensive care unit was longer for children with electrographic seizures than for children without electrographic seizures (9.5 [3-22.5] vs 2 [2-5] days, Wilcoxon test, Z = 3.916, P =.0001). Four children (4.1%) died before leaving the hospital, and we could not identify a relationship between death and the presence or absence of electrographic seizures. Conclusions After CSE, one-third of children who underwent EEG monitoring experienced electrographic seizures, and among these, one-third experienced entirely electrographic-only seizures. A previous diagnosis of epilepsy and the presence of interictal epileptiform discharges were risk factors for electrographic seizures.

AB - Objective To describe the prevalence, characteristics, and predictors of electrographic seizures after convulsive status epilepticus (CSE). Study design This was a multicenter retrospective study in which we describe clinical and electroencephalographic (EEG) features of children (1 month to 21 years) with CSE who underwent continuous EEG monitoring. Results Ninety-eight children (53 males) with CSE (median age of 5 years) underwent subsequent continuous EEG monitoring after CSE. Electrographic seizures (with or without clinical correlate) were identified in 32 subjects (33%). Eleven subjects (34.4%) had electrographic-only seizures, 17 subjects (53.1%) had electroclinical seizures, and 4 subjects (12.5%) had an unknown clinical correlate. Of the 32 subjects with electrographic seizures, 15 subjects (46.9%) had electrographic status epilepticus. Factors associated with the occurrence of electrographic seizures after CSE were a previous diagnosis of epilepsy (P =.029) and the presence of interictal epileptiform discharges (P <.0005). The median (p 25-p75) duration of stay in the pediatric intensive care unit was longer for children with electrographic seizures than for children without electrographic seizures (9.5 [3-22.5] vs 2 [2-5] days, Wilcoxon test, Z = 3.916, P =.0001). Four children (4.1%) died before leaving the hospital, and we could not identify a relationship between death and the presence or absence of electrographic seizures. Conclusions After CSE, one-third of children who underwent EEG monitoring experienced electrographic seizures, and among these, one-third experienced entirely electrographic-only seizures. A previous diagnosis of epilepsy and the presence of interictal epileptiform discharges were risk factors for electrographic seizures.

KW - CSE

KW - Convulsive status epilepticus

KW - EEG

KW - Electroencephalogram

UR - http://www.scopus.com/inward/record.url?scp=84892779589&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892779589&partnerID=8YFLogxK

U2 - 10.1016/j.jpeds.2013.09.032

DO - 10.1016/j.jpeds.2013.09.032

M3 - Article

C2 - 24161223

AN - SCOPUS:84892779589

SN - 0022-3476

VL - 164

SP - 339-346.e2

JO - journal of pediatrics

JF - journal of pediatrics

IS - 2

ER -

Electrographic seizures after convulsive status epilepticus in children and young adults: A retrospective multicenter study

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this