Authors :
Presenting Author: Rajib Kanti Dey, MBBS – Boston Children's Hospital
Fatemeh Mohmmad Alizadeh Chafjiri, MD – Boston Children's Hospital
Sahar Rostamian, MD – Boston Children's Hospital
Luisa Atunes Ortega, MD – Boston Children's Hospital
Leena Abdelmoity, MD Candidate – Boston Children's Hospital
Stephanie Dailey, BA – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Elijah Simon, BS – Boston Children's Hospital
Jennifer Gettings, BMBS, FRCPC – Boston Children's Hospital
Agnieszka Kielian, MD – Boston Children's Hospital
Tobias Loddenkemper, MD – Boston Children's Hospital
Rationale:
Refractory status epilepticus (RSE) is a neurological emergency in pediatric patients, necessitating prompt diagnosis and intervention. RSE was defined as seizure activity unresponsive to both a benzodiazepine and the first non-benzodiazepine anti-seizure medication (ASM), or seizures requiring continuous infusion of ASM for control. Electroencephalography (EEG) is essential for confirming ongoing seizure activity and guiding treatment decisions. This study aimed to analyze the timing of EEG initiation and its variation across demographic and clinical characteristics in pediatric patients with RSE.
Methods:
We conducted a retrospective analysis of pediatric patients (aged 1 month to 21 years) admitted with convulsive RSE to Boston Children’s Hospital from 2013 to 2023. Of 212 identified cases, 49 patients did not undergo EEG, 2 received intracranial EEG, and 44 were excluded due to insufficient data, yielding a final cohort of 117 patients who underwent continuous EEG monitoring. Median values and interquartile ranges (IQR, 25th–75th percentile) were calculated using descriptive statistics. Univariate analyses were performed using Mann-Whitney U, Kruskal-Wallis, and Spearman correlation. Multivariate linear regression (with log-transformed time to EEG as the dependent variable) was conducted, adjusting for age, sex, race, ethnicity, seizure onset location, location at EEG initiation, seizure semiology, seizure etiology, seizure duration, time to first ASM, history of seizures, and pre-existing epilepsy.
Results:
We included 117 patients (53.8% male; median age 5.0 years, IQR 1.6–13.5). Median time from RSE onset to EEG was 7.83 hours (IQR 4.17–15.22; n=117). Median time to first ASM was 28 minutes (IQR 8.0–61.0; n=63). Median RSE duration was 120 minutes (IQR 64.75–283.5; n=80). Median ICU admission duration was 2.7 days (IQR 1.5–8.1; n=96 patients admitted to the ICU after RSE onset).
Table 1 summarizes EEG initiation timing across subgroups. After adjusting for covariates, only patients who developed RSE during hospitalization had a shorter time to EEG (median 3.59 hours; IQR 2.19–4.68) compared to those presenting with out-of-hospital RSE (median 10.93 hours; IQR 6.73-18.00; p< .05)