Nicholas S Abend, France W Fung, Darshana S Parikh, Mark Ramos, Rui Xiao, Alexis A Topjian
ASM use in critically ill children was common and associated with clinical and electrographic seizures/SE but frequently extended beyond documented seizures. Levetiracetam predominated as the first-administered ASM, and many treated patients received multiple ASMs. ASM prescribing at discharge remained common and was associated with seizures and structural etiology. These findings demonstrate substantial variability in subsequent ASM selection and support evaluation of risk-guided approaches to ASM initiation and continuation.
PURPOSE: We characterized anti-seizure medication (ASM) prescribing during hospitalization and at discharge in critically ill children undergoing continuous electroencephalography (CEEG) and identified clinical and electrographic factors associated with inpatient ASM administration and discharge prescribing.
METHODS: This prospective cohort included consecutive children with acute encephalopathy undergoing CEEG in a pediatric intensive care unit, excluding those with pre-existing epilepsy. ASM use during hospitalization and prescribing at discharge were evaluated.
RESULTS: Among 705 patients, 54% received ASM. Levetiracetam was the predominant first-administered non-benzodiazepine ASM (88%), and 67% of treated patients received ≥2 ASMs. Inpatient ASM use was independently associated with electrographic seizures/status epilepticus (ES/ESE) during CEEG (OR 19.73), clinical seizures/status epilepticus (SE) before CEEG (OR 3.77), acute structural etiology (OR 2.20), and abnormal EEG background (discontinuous OR 3.17; slow-disorganized OR 1.80). Among patients without clinical seizures/SE documented before CEEG or ES/ESE identified during CEEG, 34% received ASM. Among 590 survivors, 37% were discharged on ASM. Discharge ASM prescribing was associated with ES/ESE (OR 4.79), clinical seizures/SE before CEEG (OR 2.18), acute structural etiology (OR 2.43), epileptiform discharges (OR 1.76), and abnormal EEG background (discontinuous OR 3.13; slow-disorganized OR 1.57). Among patients without clinical seizures/SE documented before CEEG or ES/ESE identified during CEEG, 23% were discharged on ASM.
CONCLUSION: ASM use in critically ill children was common and associated with clinical and electrographic seizures/SE but frequently extended beyond documented seizures. Levetiracetam predominated as the first-administered ASM, and many treated patients received multiple ASMs. ASM prescribing at discharge remained common and was associated with seizures and structural etiology. These findings demonstrate substantial variability in subsequent ASM selection and support evaluation of risk-guided approaches to ASM initiation and continuation.