- Subsequent seizure or epilepsy occurred in 64% of critically ill children after ASyS, strongly linked to prior clinical or electrographic seizures.
- A simple four-variable Seizure/Epilepsy Risk Score predicted subsequent diagnoses with good discrimination (AUC 0.81), risk ranging from 13% to 96%.
- After propensity adjustment, discharge on antiseizure medication was not associated with reduced subsequent seizure or epilepsy risk (IPTW adjusted OR 1.03, p = 0.92).
Epilepsia. 2026 Aug 22. doi: 10.1002/epi.70452. Online ahead of print.
ABSTRACT
OBJECTIVE: We aimed to determine the risk of subsequent seizure or epilepsy diagnosis after acute symptomatic seizures (ASyS) in critically ill children, evaluate whether antiseizure medication (ASM) use is associated with subsequent seizure/epilepsy diagnosis, and develop a simple Seizure/Epilepsy Risk Score to predict subsequent seizure/epilepsy diagnosis.
METHODS: This was a prospective observational cohort study of consecutive children with acute encephalopathy undergoing clinically indicated continuous electroencephalographic (CEEG) monitoring in a pediatric intensive care unit. Patients with pre-existing epilepsy were excluded. Follow-up data were obtained to assess subsequent seizure/epilepsy diagnoses. Multivariable logistic regression and time-to-event analyses were used. Propensity score methods using inverse probability of treatment-weighted logistic regression were used to evaluate the association between discharge ASM use and subsequent seizure/epilepsy diagnoses.
RESULTS: Among 365 patients with follow-up, a subsequent seizure/epilepsy diagnosis occurred in 64%. Subsequent seizure/epilepsy diagnosis was strongly associated with clinical seizures or status epilepticus prior to CEEG (odds ratio [OR] = 8.03, 95% confidence interval [CI] = 4.64-13.88), electrographic seizures or status epilepticus during CEEG (OR = 6.13, 95% CI = 2.36-15.91), and ASM administration during the admission (OR = 3.22, 95% CI = 1.79-5.80). A four-variable Seizure/Epilepsy Risk Score demonstrated generally increasing risk (13%-96%) with good discrimination (area under the receiver operating characteristic curve = .81). After propensity score adjustment, patients discharged on ASM had similar risk of subsequent seizure/epilepsy diagnosis compared with those discharged off ASM (inverse probability of treatment weighting-adjusted OR = 1.03, 95% CI = .61-1.72, p = .92).
SIGNIFICANCE: Subsequent seizure or epilepsy diagnoses are common after ASyS in critically ill children and are strongly associated with acute clinical and electrographic seizure occurrence. A simple Seizure/Epilepsy Risk Score predicted subsequent seizure or epilepsy diagnoses, supporting early risk stratification. Patients discharged on or off ASM had a similar risk of subsequent seizure or epilepsy diagnoses.
PMID:42631926 | DOI:10.1002/epi.70452
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