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Intensive Care Medicine

, Volume 38, Issue 5, pp 853–862

First Online: 11 April 2012Received: 21 December 2010Accepted: 02 March 2012

Abstract

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

MethodscEEG 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.

ResultsOf 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.

ConclusionSeizures 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.

KeywordsSeizures Status epilepticus Coma Child Outcome  Download fulltext PDF



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