Nonconvulsive seizures and status epilepticus in pediatric head trauma: A national survey

Abstract

Objectives:

It remains uncertain whether nonconvulsive seizures and nonconvulsive status epilepticus in pediatric traumatic brain injury are deleterious to the brain and/or impact the recovery from injury. Consequently, optimal electroencephalographic surveillance and management is unknown. We aimed to determine specialists’ opinion regarding the detection and treatment of nonconvulsive seizures or nonconvulsive status epilepticus in pediatric traumatic brain injury, regardless of their practice.

Methods:

In 2012, 183 surveys were sent to all 93 neurologists, 27 neurosurgeons, and 63 intensivists in the14 tertiary pediatric hospitals across Canada. The survey included an initial scenario of pediatric TBI that evolved into three further scenarios. Each scenario had required responses and an embedded branching logic algorithm ascertaining clinical management. The survey instrument assimilated data about the importance of nonconvulsive status epilepticus and nonconvulsive seizures detection and treatment, and whether they are a cause of brain injury that adversely affects neurologic outcomes.

Results:

Of the 79 specialists who replied (43% response rate), 68%–78% elected to order an electroencephalographic across all four scenarios, and one-third (31%–36%; scenario dependent) would request an urgent electroencephalographic (within the hour) in the comatose pediatric traumatic brain injury patient. In the absence of pharmacologic paralysis or intracranial pressure spikes, half-hour electroencephalographic (41%–55%) was preferred over ⩾24-h continuous electroencephalographic monitoring (29%–40%). Finally, nonconvulsive status epilepticus (81%–87%) and nonconvulsive seizures (61%–73%) were considered to be a cause of poor neurologic outcomes warranting aggressive pharmacologic management.

Conclusion:

The Canadian specialists’ opinion is that nonconvulsive seizures and nonconvulsive status epilepticus are biomarkers of brain injury and contribute to worsened outcomes. This suggests the urgency of future outcome-oriented research in the identification and management of nonconvulsive seizures or nonconvulsive status epilepticus.