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Open Access 01-05-2012 | Pediatric Original

Seizures in 204 comatose children: incidence and outcome

Authors: Fenella J. Kirkham, Angela M. Wade, Fiona McElduff, Stewart G. Boyd, Robert C. Tasker, Melinda Edwards, Brian G. R. Neville, Norbert Peshu, Charles R. J. C. Newton

Published in: Intensive Care Medicine | Issue 5/2012

Abstract

Purpose

Seizures are common in comatose children, but may be clinically subtle or only manifest on continuous electroencephalographic monitoring (cEEG); any association with outcome remains uncertain.

Methods

cEEG (one to three channels) was performed for a median 42 h (range 2–630 h) in 204 unventilated and ventilated children aged ≤15 years (18 neonates, 61 infants) in coma with different aetiologies. Outcome at 1 month was independently determined and dichotomized for survivors into favourable (normal or moderate neurological handicap) and unfavourable (severe handicap or vegetative state).

Results

Of the 204 patients, 110 had clinical seizures (CS) before cEEG commenced. During cEEG, 74 patients (36 %, 95 % confidence interval, 95 % CI, 32–41 %) had electroencephalographic seizures (ES), the majority without clinical accompaniment (non-convulsive seizures, NCS). CS occurred before NCS in 69 of the 204 patients; 5 ventilated with NCS had no CS observed. Death (93/204; 46 %) was independently predicted by admission Paediatric Index of Mortality (PIM; adjusted odds ratio, aOR, 1.027, 95 % CI 1.012–1.042; p < 0.0005), Adelaide coma score (aOR 0.813, 95 % CI 0.700–0.943; p = 0.006), and EEG grade on admission (excess slow with >3 % fast, aOR 5.43, 95 % CI 1.90–15.6; excess slow with <3 % fast, aOR 8.71, 95 % CI 2.58–29.4; low amplitude, 10th centile <9 µV, aOR 3.78, 95 % CI 1.23–11.7; and burst suppression, aOR 10.68, 95 % CI 2.31–49.4) compared with normal cEEG, as well as absence of CS at any time (aOR 2.38, 95 % CI 1.18–4.81). Unfavourable outcome (29/111 survivors; 26 %) was independently predicted by the presence of ES (aOR 15.4, 95 % CI 4.7–49.7) and PIM (aOR 1.036, 95 % CI 1.013–1.059).

Conclusion

Seizures are common in comatose children, and are associated with an unfavourable outcome in survivors. cEEG allows the detection of subtle CS and NCS and is a prognostic tool.

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Title: Seizures in 204 comatose children: incidence and outcome
Authors: Fenella J. Kirkham
Angela M. Wade
Fiona McElduff
Stewart G. Boyd
Robert C. Tasker
Melinda Edwards
Brian G. R. Neville
Norbert Peshu
Charles R. J. C. Newton
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2529-9

2024 ASCO Annual Meeting

Springer Medicine

Seizures in 204 comatose children: incidence and outcome

Abstract

Purpose

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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