The prevalence of seizures in comatose children in the pediatric intensive care unit: A prospective video-EEG study
The prevalence of seizures in comatose children in the pediatric intensive care unit: A prospective video-EEG study
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DOI：
10.1111/j.1528-1167.2009.02517.x
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发表时间：
2010-07-01
期刊：
影响因子：
5.6
通讯作者：
Harvey, A. Simon
中科院分区：
文献类型：
--
作者：
Shahwan, Amre;Bailey, Catherine;Harvey, A. Simon
目的：在成人和新生儿重症监护病房（ICU）的研究报告，昏迷患者癫痫发作的患病率很高。在使用不同脑电图（EEG）方法的几项回顾性研究中，报告了儿科ICU中癫痫发作的患病率。我们的目的是确定前瞻性的患病率癫痫发作（临床和亚临床）昏迷的儿童在儿科ICU使用连续视频脑电图（v-EEG）monitoring.Methods：我们进行了连续的v-EEG在2个月至17岁的儿童入院的儿科ICU持续抑郁意识超过一个为期15 months.Results：我们监测100昏迷的儿童，69%在24小时内ICU入院。ICU住院时间的中位数为5天。v-EEG的中位持续时间为20 h。仅在7名患者中发现癫痫发作，其中6名患者在v-EEG检查前有癫痫发作史。所有癫痫发作记录在前3小时的v-EEG。ICU工作人员在18例监测患者中怀疑癫痫发作，其中只有4人证实epileptic seizures.Discussion：癫痫发作的发病率较低，ICU住院时间较短的儿童相比，成人和新生儿表明不同的疾病谱和神经系统反应。在儿科ICU的所有昏迷儿童中，有既往癫痫发作、癫痫或疑似癫痫发作的临床事件病史的患者的短持续时间v-EEG似乎比常规v-EEG更合适。
P>Purpose:Studies in adult and neonatal intensive care units (ICUs) report a high prevalence of epileptic seizures in comatose patients. The prevalence of seizures in pediatric ICUs is variably reported in a few retrospective studies using different electroencephalography (EEG) methods. We aimed to determine prospectively the prevalence of epileptic seizures (clinical and subclinical) in comatose children in the pediatric ICU using continuous video-EEG (v-EEG) monitoring.Methods:We performed v-EEG in consecutive children aged 2 months to 17 years admitted to the pediatric ICU with sustained depressed consciousness over a period of 15 months.Results:We monitored 100 comatose children, 69% within 24 h of ICU admission. Median length of ICU stay was 5 days. Median duration of v-EEG was 20 h. Epileptic seizures were identified in only seven patients, of whom six had a history of epilepsy with witnessed seizures immediately prior to v-EEG. All epileptic seizures were recorded in the first 3 h of v-EEG. Seizures were suspected by ICU staff in 18 monitored patients, only four of whom had confirmed epileptic seizures.Discussion:The lower prevalence of epileptic seizures and the shorter length of ICU stay in children compared to adults and neonates suggest a different spectrum of disease and neurologic response. Short-duration v-EEG in patients with a history of prior seizures, epilepsy, or clinical events suspected to be seizures seems more appropriate than routine v-EEG in all comatose children in the pediatric ICU.