Tran Lily, Welcher Rebecca, Scott Rodney
Nemours Children's Health System Division of Neurology, 1600 Rockland Rd., Wilmington, DE 19803, USA.
Children (Basel). 2023 Jan 31;10(2):258. doi: 10.3390/children10020258.
Continuous EEG (cEEG) monitoring is the gold standard for detecting electrographic seizures in critically ill children and the current consensus-based guidelines recommend urgent cEEG to detect electrographic seizures that would otherwise be undetected. The detection of seizures usually leads to the use of antiseizure medications, even though current evidence that treatment leads to important improvements in outcomes is limited, raising the question of whether the current strategies need re-evaluation. There is emerging evidence indicating that the presence of electrographic seizures is not associated with unfavorable neurological outcome, and thus treatment is unlikely to alter the outcomes in these children. However, a high seizure burden and electrographic status epilepticus is associated with unfavorable outcome and the treatment of status epilepticus is currently warranted. Ultimately, outcomes are more likely a function of etiology than of a direct effect of the seizures themselves. We suggest re-examining our current consensus toward aggressive treatment to abolish all electrographic seizures and recommend a tailored approach where therapeutic interventions are indicated when seizure burden breaches above a critical threshold that may be associated with adverse outcomes. Future studies should explicitly evaluate whether there is a positive impact of treating electrographic seizures or electrographic status epilepticus in order to justify continuing current approaches.
持续脑电图（cEEG）监测是检测危重症儿童癫痫样发作的金标准，目前基于共识的指南推荐进行紧急cEEG监测，以检测那些否则会漏诊的癫痫样发作。癫痫发作的检测通常会导致使用抗癫痫药物，尽管目前关于治疗能带来重要预后改善的证据有限，这就引发了当前策略是否需要重新评估的问题。有新证据表明，癫痫样发作的存在与不良神经预后无关，因此治疗不太可能改变这些儿童的预后。然而，癫痫发作负荷高和癫痫持续状态与不良预后相关，目前有必要对癫痫持续状态进行治疗。最终，预后更可能是病因的函数，而非癫痫发作本身的直接影响。我们建议重新审视我们目前对积极治疗以消除所有癫痫样发作的共识，并推荐一种量身定制的方法，即当癫痫发作负荷超过可能与不良后果相关的临界阈值时，进行治疗干预。未来的研究应明确评估治疗癫痫样发作或癫痫持续状态是否有积极影响，以证明继续采用当前方法的合理性。
