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To know or not to know: does EEG monitoring in the paediatric intensive care unit add anything besides cost?

Gregory L. Holmes
DOI: http://dx.doi.org/10.1093/brain/awu080 1276-1277 First published online: 25 April 2014

You are called to the intensive care unit to see a 6-year-old girl admitted with encephalitis. The child presented with 2 days of fever, confusion and lethargy and was admitted following a generalized tonic-clonic seizure lasting 8 min, which was treated with intravenous lorazepam followed by levetiracetam. When you see the child she is stuporous and does not respond to verbal commands but shows no clinical signs of ongoing seizures. The staff in the intensive care unit wish to know whether they should call in a technician to obtain an EEG. In a child who has already had a convulsive seizure, is on antiepileptic therapy and is showing no signs of ongoing seizure activity, will EEG monitoring add anything to her management? In the current issue of Brain, Payne et al. (2014) provide evidence to suggest that it might.

There is a long-standing controversy as to whether seizures, either clinical or subclinical, are harmful in critically ill children. Many clinicians are of the mindset that the aetiology of seizures is the determinant of outcome and that seizures themselves are simply a reflection of the severity of the underlying condition. In a condition such as encephalitis, it is argued, children with more severe disease are more …