Treatment of electrographic seizures and status epilepticus in critically ill children: a single center experience.

Treatment of electrographic seizures and status epilepticus in critically ill children: a single center experience.
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DOI:
10.1016/j.seizure.2013.03.008
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发表时间:
2013-07
影响因子:
3
通讯作者:
Topjian, Alexis A.
Topjian, Alexis A.
中科院分区:
医学3区
文献类型:
--
作者:
Abend, Nicholas S.;Sanchez, Sarah M.;Berg, Robert A.;Dlugos, Dennis J.;Topjian, Alexis A.

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电描记癫痫发作(ES)和电描记癫痫持续状态(ESE)在儿科重症监护室(PICU)的脑病儿童中很常见,并与不良的短期结局相关。调查数据表明,大多数医生治疗ES和ESE与抗癫痫药物(AED),但很少有关于AED的使用模式的数据。我们的目的是描述AED的使用ES和ESE的危重患儿。我们进行了一项观察性研究的患者进行连续脑电图(cEEG)监测在PICU的一个单一的四级护理儿童医院。我们收集了有关年龄、临床诊断、ES和ESE发生率以及使用的AED的数据。200例受试者接受了cEEG。ES发生率为21%(41/200),ESE发生率为22%(43/200)。在84例ES或ESE患者中,80例接受非苯二氮卓类AED,包括48%(38/80)的ES和52%(42/80)的ESE。最常首次使用的AED为左乙拉西坦(38%)(30/80)、苯巴比妥(31%)(25/80)、苯妥英-磷苯妥英(28%)(22/80)和丙戊酸盐(4%)(3/80)。ES组74%(28/38)和ESE组22%(9/41)在首次使用AED后癫痫发作终止。在我们中心,左乙拉西坦、苯巴比妥和苯妥英-磷苯妥英通常用于治疗ES和ESE。超过一半的受试者接受了多种AED。
Electrographic seizures (ES) and electrographic status epilepticus (ESE) are common in encephalopathic children in the pediatric intensive care unit (PICU) and associated with worse short-term outcome. Survey data indicate most physicians treat ES and ESE with antiepileptic drugs (AEDs), but few data are available regarding AED usage patterns. We aimed to describe AED usage for ES and ESE in critically ill children. We performed an observational study of patients who underwent continuous electroencephalographic (cEEG) monitoring in the PICU of a single quaternary care children’s hospital. We collected data regarding age, clinical diagnoses, ES and ESE occurrence, and AEDs utilized. 200 subjects underwent cEEG. ES occurred in 21% (41/200) and ESE occurred in 22% (43/200). Of the 84 patients with ES or ESE, 80 received non-benzodiazepine AEDs including 48% (38 of 80) with ES and 52% (42 of 80) with ESE. The most commonly administered first AEDs were levetiracetam in 38% (30/80), phenobarbital in 31% (25/80), phenytoin-fosphenytoin in 28% (22/80), and valproate in 4% (3/80). Seizures terminated after administration of the first AED in 74% (28/38) with ES and 22% (9/41) with ESE. Levetiracetam, phenobarbital, and phenytoin-fosphenytoin are commonly used to manage ES and ESE at our center. Over half of subjects received multiple AEDs.
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