Utility and Prognostic Implications of Continuous Electroencephalogram Monitoring in Pediatric Intensive Care

Abstract

Background

Continuous electroencephalography (cEEG) is increasingly used in pediatric intensive care units (PICUs), but data on its diagnostic yield and prognostic value in critically ill children remain limited. This study evaluated EEG monitoring practices, seizure detection, treatment changes, and long-term epilepsy outcomes in a tertiary PICU.

Methods

We retrospectively analyzed 184 children (1 month–18 years) who underwent intermittent EEG or cEEG in a tertiary PICU between 2018 and 2022. Demographic and clinical features, EEG indications and findings, antiseizure treatment modifications, and outcomes were obtained from medical records. Primary outcomes were acute seizure control, occurrence of nonconvulsive status epilepticus (NCSE), and development of drug-resistant epilepsy (DRE) during follow-up.

Results

Ninety-eight patients (53.2%) had clinical seizures, and 86 (46.8%) underwent EEG for altered mental status or suspected encephalopathy. cEEG was used in 102/184 and intermittent EEG in 82/184 patients. Electrographic seizures were detected in 22/184 (12.0%); antiseizure therapy was modified in 17/22 based on EEG, and previously unsuspected nonconvulsive seizures were identified in 5/184 (2.7%). Acute seizure control during the PICU stay was achieved in 99/101 (98.0%) patients with documented seizures. Over a median follow-up of 8.0 months, newly diagnosed DRE occurred in 38/184 (20.7%), predominantly in patients with acute encephalopathy, hypoxic–ischemic injury, or central nervous system (CNS) infection.

Conclusion

In this pediatric PICU cohort, EEG—especially cEEG in high-risk patients—provided relevant information by improving electrographic seizure detection and guiding antiseizure management, while revealing a long-term burden of DRE. Prospective multicenter studies are needed to define the optimal role of EEG in pediatric neurocritical care.

Keywords

pediatric intensive care - continuous electroencephalography - nonconvulsive status epilepticus - long-term prognosis - drug-resistant epilepsy

Contributors' Statement

A.K.: Conceptualization, data curation, investigation, writing–original draft. F.D.: Data curation, methodology, resources. E.Ç.: Formal analysis, validation, writing–original draft. N.U.T.: Formal analysis, resources, software, writing–original draft. O.D.: Methodology, supervision, writing–review and editing.

Publikationsverlauf

Eingereicht: 20. September 2025

Angenommen: 16. Dezember 2025

Accepted Manuscript online:
17. Dezember 2025

Artikel online veröffentlicht:
24. Dezember 2025

• References

• 1 Sanchez SM, Carpenter J, Chapman KE. et al; Pediatric Critical Care EEG Group. Pediatric ICU EEG monitoring: Current resources and practice in the United States and Canada. J Clin Neurophysiol 2013; 30 (02) 156-160
• 2 Abend NS, Gutierrez-Colina AM, Topjian AA. et al. Nonconvulsive seizures are common in critically ill children. Neurology 2011; 76 (12) 1071-1077
• 3 Abend NS, Chapman KE, Gallentine WB. et al; Pediatric Critical Care EEG Group (PCCEG) and the Critical Care EEG Monitoring Research Consortium (CCEMRC). Electroencephalographic monitoring in the pediatric intensive care unit. Curr Neurol Neurosci Rep 2013; 13 (03) 330
• 4 Hussain N, Appleton R, Thorburn K. Aetiology, course and outcome of children admitted to paediatric intensive care with convulsive status epilepticus: A retrospective 5-year review. Seizure 2007; 16 (04) 305-312
• 5 Abend NS, Arndt DH, Carpenter JL. et al. Electrographic seizures in pediatric ICU patients: Cohort study of risk factors and mortality. Neurology 2013; 81 (04) 383-391
• 6 Fisher RS, Acevedo C, Arzimanoglou A. et al. ILAE official report: A practical clinical definition of epilepsy. Epilepsia 2014; 55 (04) 475-482
• 7 Scheffer IE, Berkovic S, Capovilla G. et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017; 58 (04) 512-521
• 8 Kwan P, Arzimanoglou A, Berg AT. et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2010; 51 (06) 1069-1077
• 9 Jasper HH. The ten-twenty electrode system of the International Federation. Electroencephalogr Clin Neurophysiol 1958; 10: 371-375
• 10 Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004; 62 (10) 1743-1748
• 11 Wilson CA. Continuous electroencephalogram detection of non-convulsive seizures in the pediatric intensive care unit: Review of the utility and impact on management and outcomes. Transl Pediatr 2015; 4 (04) 283-289
• 12 Topjian AA, Gutierrez-Colina AM, Sanchez SM. et al. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med 2013; 41 (01) 215-223
• 13 Ayanoğlu M, Yiş U, Kalafatçılar İ, Köker A, Arslan G, Hız S. Çocuk yoğun bakım ünitesinde izlenen olguların elektroensefalografi sonuçlarının geriye dönük olarak değerlendirilmesi. [In Turkish]. Pamukkale Med J 2021; 14 (04) p804-p810
• 14 Jette N, Claassen J, Emerson RG, Hirsch LJ. Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 2006; 63 (12) 1750-1755
• 15 Abend NS, Dlugos DJ. Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol 2007; 37 (03) 165-170
• 16 Saengpattrachai M, Sharma R, Hunjan A. et al. Nonconvulsive seizures in the pediatric intensive care unit: Etiology, EEG, and brain imaging findings. Epilepsia 2006; 47 (09) 1510-1518
• 17 Abend NS, Topjian A, Ichord R. et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology 2009; 72 (22) 1931-1940
• 18 Balcı ÖÖ, Şimşek E, Yazıcı Özkaya P. et al. Continuous EEG monitoring in critically ill children and prognostic factors for short-term outcome: An observational study. J Pediatr Rev 2022; 9 (03) 228-235
• 19 Anık A, Tekgül H, Yılmaz S. et al. The prognostic role of clinical, electroencephalographic and neuro-radiological parameters in predicting outcome in pediatric non-traumatic coma. Pamukkale Med. J. 2020; 13 (03) 509-518