Hansen Gregory, Joffe Ari R, Bowman Stephen M, Richer Lawrence
University of Manitoba, Winnipeg, MB, Canada.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
SAGE Open Med. 2015 Feb 27;3:2050312115573817. doi: 10.1177/2050312115573817. eCollection 2015.
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.
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.
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.
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.
小儿创伤性脑损伤中的非惊厥性癫痫发作和非惊厥性癫痫持续状态是否对大脑有害和/或影响损伤恢复仍不确定。因此，最佳的脑电图监测和管理尚不清楚。我们旨在确定专家们对于小儿创伤性脑损伤中非惊厥性癫痫发作或非惊厥性癫痫持续状态的检测和治疗的看法，无论他们的执业情况如何。
2012年，向加拿大14家三级儿科医院的所有93名神经科医生、27名神经外科医生和63名重症监护医生发送了183份调查问卷。该调查包括一个小儿创伤性脑损伤的初始病例，该病例演变成另外三个病例。每个病例都有要求回答的问题以及一个确定临床管理的嵌入式分支逻辑算法。该调查工具收集了有关非惊厥性癫痫持续状态和非惊厥性癫痫发作检测与治疗的重要性的数据，以及它们是否是对神经学预后产生不利影响的脑损伤原因的数据。
在回复的79名专家中（回复率为43%），68%-78%的专家在所有四种病例情况下都选择进行脑电图检查，三分之一（31%-36%；取决于病例情况）的专家会要求对昏迷的小儿创伤性脑损伤患者进行紧急脑电图检查（在一小时内）。在没有药物性麻痹或颅内压峰值的情况下，半小时脑电图检查（41%-55%）比≥24小时的连续脑电图监测（29%-40%）更受青睐。最后，非惊厥性癫痫持续状态（81%-87%）和非惊厥性癫痫发作（61%-73%）被认为是导致神经学预后不良的原因，需要积极的药物治疗。
加拿大专家们的观点是，非惊厥性癫痫发作和非惊厥性癫痫持续状态是脑损伤的生物标志物，并会导致预后恶化。这表明未来针对非惊厥性癫痫发作或非惊厥性癫痫持续状态的识别和管理进行以结果为导向的研究具有紧迫性。
