Status Epilepticus in the PICU: Quieting the Storm
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CRITICAL CARE (N NOVISKI, SECTION EDITOR)
Status Epilepticus in the PICU: Quieting the Storm David T. Hsieh • Elizabeth A. Thiele
Published online: 8 January 2013 Springer Science + Business Media New York 2013
Abstract Status epilepticus (SE), defined by either a prolonged seizure or a prolonged period of recurrent seizures without a return to baseline in-between seizures, is a neurological emergency frequently encountered in the pediatric intensive care unit (PICU). Pediatric SE, in addition to itself leading to PICU admission, occurs commonly in critically ill children. The clinical manifestations of SE are increasingly being recognized as presenting in a widely heterogeneous manner, particularly in the PICU. Subtler presentations can include altered mental status with or without suggestive motor movements. Thus, the initial fundamental task in managing pediatric SE is astute recognition and diagnosis, which often requires both clinical acumen and electroencephalography. This, in turn, allows for prompt management with concurrent evaluation and treatment. In this article, we will review the diagnosis, evaluation, and treatment of SE occurring in the setting of the PICU, with a focus on bringing the reader up-to-date on these topics. Keywords Electroencephalography Status epilepticus Intensive care units Pediatric
D. T. Hsieh Division of Child Neurology, Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Dr, Ft Sam Houston, TX 78234, USA e-mail: [email protected] E. A. Thiele (&) Pediatric Epilepsy Program, Department of Neurology, Massachusetts General Hospital, 175 Cambridge Street, Suite 340, Boston, MA 02114-2796, USA e-mail: [email protected]
Introduction Status epilepticus (SE) is a neurological emergency defined by either a prolonged seizure or a prolonged period of recurrent seizures without a return to baseline in-between seizures. Pediatric SE, in addition to itself being a neurological emergency leading to admission and requiring intensive care, occurs commonly in critically ill children, and is therefore frequently encountered in the pediatric intensive care unit (PICU) [1]. Although the analogy of a ‘‘storm’’ may invoke the visual scenario of a child in a continuous generalized tonic–clonic seizure, the clinical manifestations of SE are increasingly becoming recognized to present in a widely heterogeneous manner, particularly in the PICU. Subtler presentations of SE in the PICU, due in part to the common use of sedative and neuromuscularblocking agents in the setting of critically ill children, can include altered mental status with or without suggestive motor movements. Thus, the initial fundamental task in managing pediatric SE—‘‘quieting the storm’’—is astute recognition and diagnosis, which in the PICU often requires both clinical acumen and neurophysiological monitoring with electroencephalography (EEG). This, in turn, allows for prompt management with concurrent evaluation and treatment.
Defining Pediatric Status Epilepticus The classical definit
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