The clinical, electrographic, and laboratory findings of patients with seizure followed-up in the pediatric intensive care unit, and their effect on prognosis

Abstract

Aim: To investigate the clinical characteristics of seizures, treatment options, and electroencephalographic, laboratory findings and factors affecting the prognosis of children admitted to the pediatric intensive care unit (PICU).

Method: The demographic, clinical, electrophysiological, and laboratory findings of patients under follow-up due to seizures in the PICU between January and December 2020 were investigated retrospectively.

Results: One hundred fifty-two patients, 90 (60%) of whom were boys, were included in the study. The patients’ mean age was 45.08±40.40 months (range 1-208 months), the mean length of stay was 2.29±2.09 days, and 83 (53.5%) presented due to seizures and were diagnosed with epilepsy. Sixty-nine (44.5%) patients presented with first seizures. Etiological factors were idiopathic in 67 cases (43.3%), constitutional seizures in 37 cases (23.9%), fever and infection in 31 cases (24.5%), autoimmune encephalitis in 4 cases (2.6%), and post-traumatic in 16 cases (10.3%). Complete seizure control was achieved in 89 (57.4%) patients and partial control in 62 (40%), while mortality occurred in one case (0.7%). Cranial magnetic resonance imaging was performed on 54 patients, of whom 50 (32.8%) exhibited pathological findings. Neuromotor developmental delay was present in 47 (30.3%) patients. Sixteen (10.3%) were diagnosed with cerebral palsy, 17 (11%) with neuropsychiatric disease, and 12 (7.7%) with structural brain malformation (Dandy Walker syndrome, chromosomal disease, and neurogenetic syndromes). A comparison of the patients in whom complete and partial seizure control was achieved revealed that seizure control was more difficult in cases with accompanying cerebral malformation, with chronic disease, with neuromotor developmental delay, with histories of admission to the neonatal ICU, and with histories of perinatal asphyxia, and this was found to be statistically significant (p<0.018, p<0.008, p<0.017, and p<0.001, respectively).

Conclusion: Rapid and effective interventions can be planned by identifying the clinical characteristics and etiologies of patients followed-up in the PICU due to seizures, and by considering that seizures may be prolonged, difficult to control, and recurring in patients with accompanying factors that adversely affect seizure prognosis.