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Chafjiri FMA, Reece L, Voke L, Landschaft A, Clark J, Kimia AA, Loddenkemper T. Natural language processing for identification of refractory status epilepticus in children. Epilepsia 2023; 64:3227-3237. [PMID: 37804085 DOI: 10.1111/epi.17789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE Pediatric status epilepticus is one of the most frequent pediatric emergencies, with high mortality and morbidity. Utilizing electronic health records (EHRs) permits analysis of care approaches and disease outcomes at a lower cost than prospective research. However, reviewing EHR manually is time intensive. We aimed to compare refractory status epilepticus (rSE) cases identified by human EHR review with a natural language processing (NLP)-assisted rSE screen followed by a manual review. METHODS We used the NLP screening tool Document Review Tool (DrT) to generate regular expressions, trained a bag-of-words NLP classifier on EHRs from 2017 to 2019, and then tested our algorithm on data from February to December 2012. We compared results from manual review to NLP-assisted search followed by manual review. RESULTS Our algorithm identified 1528 notes in the test set. After removing notes pertaining to the same event by DrT, the user reviewed a total number of 400 notes to find patients with rSE. Within these 400 notes, we identified 31 rSE cases, including 12 new cases not found in manual review, and 19 of the 20 previously identified cases. The NLP-assisted model found 31 of 32 cases, with a sensitivity of 96.88% (95% CI = 82%-99.84%), whereas manual review identified 20 of 32 cases, with a sensitivity of 62.5% (95% CI = 43.75%-78.34%). SIGNIFICANCE DrT provided a highly sensitive model compared to human review and an increase in patient identification through EHRs. The use of DrT is a suitable application of NLP for identifying patients with a history of recent rSE, which ultimately contributes to the implementation of monitoring techniques and treatments in near real time.
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Affiliation(s)
- Fatemeh Mohammad Alizadeh Chafjiri
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Latania Reece
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Nexamp, Boston, Massachusetts, USA
| | - Lillian Voke
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Justice Clark
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amir A Kimia
- Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Connecticut Children's Hospital, Hartford, Connecticut, USA
| | - Tobias Loddenkemper
- Department of Neurology, Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tsai CM, Chang SF, Chang H. Transcranial photobiomodulation add-on therapy to valproic acid for pentylenetetrazole-induced seizures in peripubertal rats. BMC Complement Med Ther 2022; 22:81. [PMID: 35313886 PMCID: PMC8935768 DOI: 10.1186/s12906-022-03562-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background Convulsive status epilepticus (CSE) prevention is critical for pediatric patients with epilepsy. Immediate intervention before CSE reduce severity. Despite its wide usage as an anticonvulsant, valproic acid (VPA) results in harmful side effects such as dose-dependent hepatotoxicity. Hence, reducing VPA dosage to minimize side effects while maintaining its efficacy is necessary, and transcranial photobiomodulation (tPBM) add-on therapy could facilitate this. We recently demonstrated for the first time that tPBM at a wavelength of 808 nm attenuated CSE in peripubertal rats. However, the effects of VPA with the add-on therapy of tPBM prior to seizures have not yet been explored. This study investigated whether adding tPBM to VPA exerts synergistic effect for CSE prevention in peripubertal rats. Methods A gallium-aluminum-arsenide laser (wavelength of 808 nm with an exposure duration of 100 s and irradiance of 1.333 W/cm2 at the target) was applied transcranially 30 min after VPA injection in Sprague Dawley rats. All the rats received 90 mg/kg of pentylenetetrazole (PTZ). Except for the saline (n = 3), tPBM + saline (n = 3), and PTZ group (n = 6), all the rats received a PTZ injection 30 min after VPA injection. The rats received add-on tPBM with PTZ immediately after tPBM. In the VPA + PTZ group, the rats received low-dose (100 mg/kg, n = 6), medium-dose (200 mg/kg, n = 6), and high-dose (400 mg/kg, n = 7) VPA. In the VPA + tPBM + PTZ group, the rats received low (100 mg/kg, n = 5), medium (200 mg/kg, n = 6), and high (400 mg/kg, n = 3) doses of VPA. Seizures were evaluated according to the revised Racine’s scale in a non-blinded manner. Results Adding tPBM to low-dose VPA reduced the incidence of severe status epilepticus and significantly delayed the latency to stage 2 seizures. However, adding tPBM to high-dose VPA increased the maximum seizure stage, prolonged the duration of stage 4–7 seizures, and shortened the latency to stage 6 seizures. Conclusions Adding tPBM to low-dose VPA exerted a synergistic prevention effect on PTZ-induced seizures, whereas adding tPBM to high-dose VPA offset the attenuation effect.
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Affiliation(s)
- Chung-Min Tsai
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan
| | - Shwu-Fen Chang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Department of Pediatrics, Taipei Medical University Hospital, 250 Wuxing St., Taipei, 11031, Taiwan.
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3
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Pathania V, Guglani V, Azad C, Jain S, Kaur R, Singh DK. Disability and Mortality in Convulsive Status Epilepticus in Children at 3 Months' Follow-Up: A Prospective Study from India. J Neurosci Rural Pract 2022; 13:211-217. [PMID: 35694062 PMCID: PMC9187372 DOI: 10.1055/s-0042-1743212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
Convulsive status epilepticus (CSE) is a common neurological emergency with high mortality, morbidity, and poor quality of life. There is a paucity of follow-up studies from developing nations in pediatric age group.
Objectives
This article looks for clinico-etiological profile of CSE and estimates the immediate and short-term mortality in children with CSE and its predictive factors.
Methodology
This prospective longitudinal study was done at a tertiary care institute of Northern India. The patients between the ages of 1 and 16 years with CSE were enrolled after informed consent, they were observed in the hospital, and survived patients were followed till 3 months after discharge.
Results
A total of 200 patients (58% males) were enrolled. Acute symptomatic (63.5%) was the most common etiology. Twenty-five (12.5%) patients died during hospital stay; at discharge, 160 (80%) had good recovery and rest had a varying range of disability. The predictive factors for poor outcome were female gender, duration of CSE > 1 hour at presentation, generalized seizures, Glasgow Coma Scale < 8 at presentation, refractory status epilepticus, need for critical care support, and acute symptomatic etiology. On follow-up, two patients died at 1-month and one at 3-month follow-up, the cause of death was probably seizures in two patients and feed aspiration in one patient. Seven patients deteriorated from good recovery scoring to moderate disability during the time interval between first and second follow-up, none of them reported apparent repeat seizures.
Conclusion
Pediatric CSE is associated with immediate poor outcome; risk of death and new disabilities persist after discharge thus proper follow-up is essential.
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Affiliation(s)
- Vansha Pathania
- Department of Paediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Vishal Guglani
- Department of Paediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Chandrika Azad
- Department of Paediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Suksham Jain
- Department of Neonatology, Government Medical College and Hospital, Chandigarh, India
| | - Ravinder Kaur
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Dharmendra Kumar Singh
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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4
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Wu J, Lan X, Yan L, Hu Y, Hong S, Jiang L, Chen J. A retrospective study of 92 children with new-onset refractory status epilepticus. Epilepsy Behav 2021; 125:108413. [PMID: 34794014 DOI: 10.1016/j.yebeh.2021.108413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 01/10/2023]
Abstract
Little is known of the etiology, course, and treatment of new-onset refractory status epilepticus (NORSE) in children. Here we identified etiologies, electroencephalography (EEG) characteristics, and neuroimaging findings among pediatric patients with NORSE and among two patient subgroups, febrile infection-related epilepsy syndrome (FIRES) group and non-FIRES group. We also examined treatments and risk factors related to poor prognosis. Ninety-two children with NORSE were identified in Children's Hospital of Chongqing Medical University between January 1, 2010 and September 1, 2020. The end date was chosen to guarantee at least a 6-month follow-up. Our results indicated that patients with FIRES account for 90% of pediatric patients with NORSE. The clinical, EEG, and neuroimaging results and prognosis were not significantly different between the FIRES group and non-FIRES group of individuals. 68.5% of our patients had unknown etiology, and viral etiology was the most common identified cause (26.1%). Electroencephalography might have a certain diagnostic value for NORSE. A gradual increase in seizure burden was obvious from the onset of disease, and continuous or recurrent ictal discharge lasting ≥ 30 min was quite common in our study. The mortality was 22.8% in our study. Among the 71 surviving patients, the outcome at discharge was poor but improved during follow-up, and 68.5% had good or fair outcomes at their last follow-up. A poor outcome was observed in 39 of 92 cases (42%), with 43.9% and 30% of individuals in the FIRES group and non-FIRES group, respectively, having a poor outcome. The presence of super refractory status epilepticus (SRSE), electrographic seizures and nonconvulsive status epilepticus (NCSE), and diffuse cortical edema and multifocal abnormality may be related to a poor prognosis. Our analysis did not indicate that prognosis was directly related to etiology or treatment. Management of NORSE is challenging, and the role of immunotherapy warrants further investigation.
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Affiliation(s)
- Jinfeng Wu
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, China
| | - Xinghui Lan
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, China
| | - Lisi Yan
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, China
| | - Yue Hu
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, China
| | - Siqi Hong
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, China
| | - Jin Chen
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, China.
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5
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Sheehan T, Amengual-Gual M, Vasquez A, Abend NS, Anderson A, Appavu B, Arya R, Barcia Aguilar C, Brenton JN, Carpenter JL, Chapman KE, Clark J, Farias-Moeller R, Gaillard WD, Gaínza-Lein M, Glauser TA, Goldstein JL, Goodkin HP, Guerriero RM, Huh L, Jackson M, Kapur K, Kahoud R, Lai YC, McDonough TL, Mikati MA, Morgan LA, Novotny EJ, Ostendorf AP, Payne ET, Peariso K, Piantino J, Reece L, Riviello JJ, Sands TT, Sannagowdara K, Shellhaas R, Smith G, Tasker RC, Tchapyjnikov D, Topjian AA, Wainwright MS, Wilfong A, Williams K, Zhang B, Loddenkemper T. Benzodiazepine administration patterns before escalation to second-line medications in pediatric refractory convulsive status epilepticus. Epilepsia 2021; 62:2766-2777. [PMID: 34418087 PMCID: PMC9292193 DOI: 10.1111/epi.17043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Abstract
Objective This study was undertaken to evaluate benzodiazepine (BZD) administration patterns before transitioning to non‐BZD antiseizure medication (ASM) in pediatric patients with refractory convulsive status epilepticus (rSE). Methods This retrospective multicenter study in the United States and Canada used prospectively collected observational data from children admitted with rSE between 2011 and 2020. Outcome variables were the number of BZDs given before the first non‐BZD ASM, and the number of BZDs administered after 30 and 45 min from seizure onset and before escalating to non‐BZD ASM. Results We included 293 patients with a median (interquartile range) age of 3.8 (1.3–9.3) years. Thirty‐six percent received more than two BZDs before escalating, and the later the treatment initiation was after seizure onset, the less likely patients were to receive multiple BZD doses before transitioning (incidence rate ratio [IRR] = .998, 95% confidence interval [CI] = .997–.999 per minute, p = .01). Patients received BZDs beyond 30 and 45 min in 57.3% and 44.0% of cases, respectively. Patients with out‐of‐hospital seizure onset were more likely to receive more doses of BZDs beyond 30 min (IRR = 2.43, 95% CI = 1.73–3.46, p < .0001) and beyond 45 min (IRR = 3.75, 95% CI = 2.40–6.03, p < .0001) compared to patients with in‐hospital seizure onset. Intermittent SE was a risk factor for more BZDs administered beyond 45 min compared to continuous SE (IRR = 1.44, 95% CI = 1.01–2.06, p = .04). Forty‐seven percent of patients (n = 94) with out‐of‐hospital onset did not receive treatment before hospital arrival. Among patients with out‐of‐hospital onset who received at least two BZDs before hospital arrival (n = 54), 48.1% received additional BZDs at hospital arrival. Significance Failure to escalate from BZDs to non‐BZD ASMs occurs mainly in out‐of‐hospital rSE onset. Delays in the implementation of medical guidelines may be reduced by initiating treatment before hospital arrival and facilitating a transition to non‐BZD ASMs after two BZD doses during handoffs between prehospital and in‐hospital settings.
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Affiliation(s)
- Theodore Sheehan
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marta Amengual-Gual
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Pediatric Neurology Unit, Department of Pediatrics, Son Espases University Hospital, University of the Balearic Islands, Palma, Spain
| | - Alejandra Vasquez
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas S Abend
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne Anderson
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Brian Appavu
- Department of Pediatrics, University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Ravindra Arya
- Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cristina Barcia Aguilar
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Child Neurology, La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - J Nicholas Brenton
- Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jessica L Carpenter
- Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kevin E Chapman
- Departments of Pediatrics and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Justice Clark
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raquel Farias-Moeller
- Department of Neurology, Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William D Gaillard
- Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marina Gaínza-Lein
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Faculty of Medicine, Austral University of Chile, Valdivia, Chile
| | - Tracy A Glauser
- Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joshua L Goldstein
- Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Howard P Goodkin
- Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Réjean M Guerriero
- Division of Pediatric and Developmental Neurology, Departments of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Linda Huh
- Division of Neurology, Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Michele Jackson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kush Kapur
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Kahoud
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yi-Chen Lai
- Section of Pediatric Critical Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Tiffani L McDonough
- Division of Child Neurology, Department of Neurology, Columbia University Medical Center, Columbia University, New York, New York, USA
| | - Mohamad A Mikati
- Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - Lindsey A Morgan
- Departments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Edward J Novotny
- Departments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
| | - Eric T Payne
- Division of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Katrina Peariso
- Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Juan Piantino
- Division of Neurology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - Latania Reece
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - James J Riviello
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Tristan T Sands
- Division of Child Neurology, Department of Neurology, Columbia University Medical Center, Columbia University, New York, New York, USA
| | - Kumar Sannagowdara
- Department of Neurology, Division of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Renee Shellhaas
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Garnett Smith
- Department of Pediatrics, Division of Pediatric Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert C Tasker
- Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dmitry Tchapyjnikov
- Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, North Carolina, USA.,Department of Pediatrics, Montana Children's Hospital, Kalispell Regional Medical Center, Kalispell, Montana, USA
| | - Alexis A Topjian
- Critical Care and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark S Wainwright
- Departments of Neurology and Pediatrics, Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Angus Wilfong
- Department of Pediatrics, University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Korwyn Williams
- Department of Pediatrics, University of Arizona College of Medicine and Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Mitchell HK, Reddy A, Perry MA, Gathers CA, Fowler JC, Yehya N. Racial, ethnic, and socioeconomic disparities in paediatric critical care in the USA. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:739-750. [PMID: 34370979 DOI: 10.1016/s2352-4642(21)00161-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022]
Abstract
In an era of tremendous medical advancements, it is important to characterise and address inequities in the provision of health care and in outcomes. There is a large body of evidence describing such disparities by race or ethnicity and socioeconomic position in critically ill adults; however, this important issue has received less attention in children and adolescents (aged ≤21 years). This Review presents a summary of the available evidence on disparities in outcomes in paediatric critical illness in the USA as a result of racism and socioeconomic privilege. The majority of evidence of racial and socioeconomic disparities in paediatric critical care originates from the USA and is retrospective, with only one prospective intervention-based study. Although there is mixed evidence of disparities by race or ethnicity and socioeconomic position in general paediatric intensive care unit admissions and outcomes in the USA, there are striking trends within some disease processes. Notably, there is evidence of disparities in management and outcomes for out-of-hospital cardiac arrest, asthma, severe trauma, sepsis, and oncology, and in families' perceptions of care. Furthermore, there is clear evidence that critical care research is limited by under-enrolment of participants from minority race or ethnicity groups. We advocate for rigorous research standards and increases in the recruitment and enrolment of a diverse range of participants in paediatric critical care research to better understand the disparities observed, including the effects of racism and poverty. A clearer understanding of when, where, and how such disparities affect patients will better enable the development of effective strategies to inform practice, interventions, and policy.
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Affiliation(s)
- Hannah K Mitchell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Anireddy Reddy
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
| | - Mallory A Perry
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cody-Aaron Gathers
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica C Fowler
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Yehya
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA
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7
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Lu M, Faure M, Bergamasco A, Spalding W, Benitez A, Moride Y, Fournier M. Epidemiology of status epilepticus in the United States: A systematic review. Epilepsy Behav 2020; 112:107459. [PMID: 33181886 DOI: 10.1016/j.yebeh.2020.107459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Convulsive status epilepticus (CSE) is a life-threatening neurologic emergency, which is defined by the International League Against Epilepsy (ILAE) as bilateral tonic-clonic seizure activity lasting longer than 5 min, while absence status epilepticus (SE) and focal SE are specified as exceeding 10 min. Epidemiological evidence on SE is currently lacking, and the incidence is not well-known, especially in light of changes in the ILAE criteria for SE. The objectives of this systematic literature review were to describe the epidemiology of SE in the US population and the associated burden of illness. METHODS A systematic review, including literature and pragmatic searches, was conducted. Literature searches were performed using MEDLINE, Embase, BIOSIS, and Web of Science electronic databases from inception to February 2019. Pragmatic searches of the gray literature were carried out using Google, Google Scholar, conference proceedings, and ClinicalTrials.gov to identify additional sources. Only US-based studies or multinational studies reporting US data of interest were included. RESULTS In total, 69 sources were identified. The incidence of all SE in patients of all ages in the USA ranged from 18.3 to 41 per 100,000 people per year. Incidence of all-age CSE rose from 3.5 (1979) to 12.5 (2010) per 100,000 people per year. Status epilepticus incidence followed a bimodal (U-shaped) distribution, with the highest estimates in the first years of life (0-4 years) and after 60 years. Mortality associated with SE varied from 21% over 30 days to 31.2% over 10 years. For CSE, two studies reported similar in-hospital mortalities (9.2% and 10.7%). Median healthcare costs related to SE admission were approximately US$14,500 per adult (17-45 years) and US$8000 per child (0-16 years). CONCLUSIONS There is a lack of recent data on the epidemiology and healthcare burden associated with SE. Reports of SE incidence in the USA are highly variable and predate the 2015 ILAE definition of SE. However, the available data suggest a high burden of illness.
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Affiliation(s)
- Mei Lu
- Shire Development LLC, a Takeda company, Lexington, MA, United States of America.
| | - Mareva Faure
- YOLARX Consultants Inc., Montreal, Quebec, Canada
| | | | - William Spalding
- Shire Development LLC, a Takeda company, Lexington, MA, United States of America
| | - Arturo Benitez
- Shire Development LLC, a Takeda company, Lexington, MA, United States of America
| | - Yola Moride
- YOLARX Consultants Inc., Montreal, Quebec, Canada; YOLARX Consultants SARL, Paris, France; Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada; Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Martha Fournier
- Shire Development LLC, a Takeda company, Lexington, MA, United States of America
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Tsai CM, Chang SF, Chang H. Transcranial photobiomodulation attenuates pentylenetetrazole-induced status epilepticus in peripubertal rats. JOURNAL OF BIOPHOTONICS 2020; 13:e202000095. [PMID: 32362066 DOI: 10.1002/jbio.202000095] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/25/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
Convulsive status epilepticus is the most common neurological emergency in children. Transcranial photobiomodulation (tPBM) reverses elevated rodent neurotransmitters after status epilepticus (SE) yet whether tPBM can attenuate seizure behaviors remains unknown. Here, we applied near-infrared laser at wavelength 808 nm transcranially to peripubertal Sprague-Dawley rats prior to pentylenetetrazole (PTZ) injection. Hematoxylin-eosin, immunofluorescence (IF) staining with anti-parvalbumin (PV) and terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay after IF staining was performed. Behaviorally, tPBM attenuated the mean seizure score and reduced the incidence of SE and mortality. Histochemically, tPBM reduced dark neurons in the cortex, hippocampus, thalamus and hypothalamus, lessened the apoptotic ratio of parvalbumin-positive interneurons (PV-INs) and alleviated the aberrant extent of PV-positive unstained somata of PCs in the hippocampus. Conclusively, tPBM attenuated PTZ-induced seizures, SE and mortality in peripubertal rats and reduced PTZ-induced neuronal injury, apoptosis of PV-INs and preserved PV positive perisomatic inhibitory network in the hippocampus.
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Affiliation(s)
- Chung-Min Tsai
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shwu-Fen Chang
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi Chang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
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Arya A, Azad C, Mahajan V, Guglani V. Convulsive Status Epilepticus in Children: A Prospective Observational Study from India. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1712544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractConvulsive status epilepticus (CSE) is one of the commonest and life threatening pediatric neurological emergencies. Only few studies on pediatric status epilepticus (SE) are available from the Indian subcontinent. The aim was to study the etiology and immediate outcome of CSE in children getting admitted in pediatric emergency during the study period and to study association of various clinical presentations with immediate outcome. A prospective observational study was conducted in tertiary care institute of Northern India. Children aged between 1 month and 18 years with CSE were enrolled and followed up till discharge. Primary outcome was kept as hospital survival/mortality; those who survived were further graded on the basis of disability at discharge. A total of 81 patients with CSE were assessed for primary outcome. The mortality rate was found to be 15% (12/81); 83% deaths were due to acute central nervous system (CNS) infection. Ten percent of children (8/81) had disability at discharge, five had mild, and three had moderate disability. The neurocysticercosis was the most common etiology seen in 23% (19/81) of the children followed by febrile SE in 20% (13/81) of the study participants. CSE responded to first-line antiepileptic drugs (AED) in 15% children (12/81). Refractory status was seen in 13.5% (11/81) cases. Prehospital treatment was received only in 15% patients. Young age, low Glasgow coma scale score at admission, and requirement of critical care support were the factors found to be significantly associated with mortality. CSE has a high mortality especially in young children and acute CNS infections are the most common cause of it.
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Affiliation(s)
- Adhi Arya
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Chandrika Azad
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Vidushi Mahajan
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
| | - Vishal Guglani
- Department of Pediatrics, Government Medical College and Hospital, Chandigarh, India
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10
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Sidharth, Sharma S, Jain P, Mathur SB, Malhotra RK, Kumar V. Status Epilepticus in Pediatric patients Severity Score (STEPSS): A clinical score to predict the outcome of status epilepticus in children- a prospective cohort study. Seizure 2019; 71:328-332. [DOI: 10.1016/j.seizure.2019.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/07/2019] [Accepted: 09/11/2019] [Indexed: 01/04/2023] Open
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Neligan A, Noyce AJ, Gosavi TD, Shorvon SD, Köhler S, Walker MC. Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time: A Systematic Review and Meta-analysis. JAMA Neurol 2019; 76:897-905. [PMID: 31135807 DOI: 10.1001/jamaneurol.2019.1268] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Status epilepticus (SE) is associated with significant morbidity and mortality. Since the late 1990s, a more aggressive management of prolonged convulsive seizures lasting longer than 5 minutes has been advocated. Objective To determine if convulsive SE mortality has decreased during a time of increasing advocacy for out-of-hospital treatment and escalating and earlier treatment protocols for prolonged seizures and SE. Data Source This systemic review and meta-analysis on studies focused on the mortality of convulsive status epilepticus was conducted by searching MEDLINE, Embase, PsychINFO, CINAHL Plus, and the Cochrane Database of Systematic Reviews between January 1, 1990, and June 30, 2017. Study Selection Studies were excluded if they had fewer than 30 participants (<20 for refractory SE), were limited to SE of single specific etiology or an evaluation of a single treatment modality, or were studies of nonconvulsive SE. Data Extraction and Synthesis Data were abstracted and their quality was assessed via a modified Newcastle-Ottawa scale independently by 2 reviewers (A.N. and T.D.G.) using the Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines. Data were pooled using a random-effects model. Main Outcomes and Measures The main outcome measure was in-hospital mortality or 30-day case fatality expressed as proportional mortality. Results Sixty-one studies were included in the analysis. The pooled mortality ratios were 15.9% (95% CI, 12.7-19.2) for adult studies, 13.0% (95% CI, 7.2-19.0) for all-age population studies, 3.6% (95% CI, 2.0%-5.2%) for pediatric studies, and 17.3% (95% CI, 9.8-24.7) for refractory SE studies, with very high between-study heterogeneity. We found no evidence of a change in prognosis over time nor by the definition of SE used. Conclusions and Relevance The mortality of convulsive SE is higher in adults than in children and there was no evidence for improved survival over time. Although there are many explanations for these findings, they can be explained by aetiology of SE being the major determinant of mortality. However, there are potential confounders, including differences in case ascertainment and study heterogeneity. This meta-analysis highlights the need for strict international guidelines for the study of this condition.
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Affiliation(s)
- Aidan Neligan
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, England.,University College London Queen Square Institute of Neurology, Queen Square, London, England.,Preventive Neurology Unit, Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, England
| | - Alastair John Noyce
- University College London Queen Square Institute of Neurology, Queen Square, London, England.,Preventive Neurology Unit, Wolfson Institute of Preventative Medicine, Queen Mary University of London, London, England
| | | | - Simon D Shorvon
- University College London Queen Square Institute of Neurology, Queen Square, London, England
| | - Sebastian Köhler
- Maastricht University Medical Centre, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht, the Netherlands
| | - Matthew C Walker
- University College London Queen Square Institute of Neurology, Queen Square, London, England
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12
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Sánchez Fernández I, Gaínza-Lein M, Abend NS, Amengual-Gual M, Anderson A, Arya R, Brenton JN, Carpenter JL, Chapman KE, Clark J, Farias-Moeller R, Davis Gaillard W, Glauser TA, Goldstein J, Goodkin HP, Guerriero RM, Hecox K, Jackson M, Kapur K, Kelley SA, Kossoff EHW, Lai YC, McDonough TL, Mikati MA, Morgan LA, Novotny EJ, Ostendorf AP, Payne ET, Peariso K, Piantino J, Riviello JJ, Sannagowdara K, Stafstrom CE, Tasker RC, Tchapyjnikov D, Topjian AA, Vasquez A, Wainwright MS, Wilfong A, Williams K, Loddenkemper T. The onset of pediatric refractory status epilepticus is not distributed uniformly during the day. Seizure 2019; 70:90-96. [PMID: 31323566 DOI: 10.1016/j.seizure.2019.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate whether the onset of pediatric refractory status epilepticus (rSE) is related to time of day. METHOD We analyzed the time of day for the onset of rSE in this prospective observational study performed from June 2011 to May 2019 in pediatric patients (1 month to 21 years of age). We evaluated the temporal distribution of pediatric rSE utilizing a cosinor analysis. We calculated the midline estimating statistic of rhythm (MESOR) and amplitude. MESOR is the estimated mean number of rSE episodes per hour if they were evenly distributed. Amplitude is the difference between MESOR and maximum rSE episodes/hour, or between MESOR and minimum rSE episodes/hour. We also evaluated the temporal distribution of time to treatment. RESULTS We analyzed 368 patients (58% males) with a median (p25 - p75) age of 4.2 (1.3-9.7) years. The MESOR was 15.3 (95% CI: 13.9-16.8) and the amplitude was 3.2 (95% CI: 1.1-5.3), p = 0.0024, demonstrating that the distribution is not uniform, but better described as varying throughout the day with a peak in the morning (11am-12 pm) and trough at night (11 pm-12 am). The duration from rSE onset to application of the first non-benzodiazepine antiseizure medication peaked during the early morning (2am-3 am) with a minimum during the afternoon (2 pm-3 pm) (p = 0.0179). CONCLUSIONS The distribution of rSE onset is not uniform during the day. rSE onset shows a 24-h distribution with a peak in the mid-morning (11am-12 pm) and a trough at night (11 pm-12am).
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain
| | - Marina Gaínza-Lein
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Nicholas S Abend
- Division of Neurology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Marta Amengual-Gual
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Pediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma, Spain
| | - Anne Anderson
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ravindra Arya
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - J Nicholas Brenton
- Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Jessica L Carpenter
- Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kevin E Chapman
- Departments of Pediatrics and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Justice Clark
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raquel Farias-Moeller
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William Davis Gaillard
- Center for Neuroscience, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Tracy A Glauser
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joshua Goldstein
- Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Howard P Goodkin
- Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Réjean M Guerriero
- Division of Pediatric and Developmental Neurology, Departments of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kurt Hecox
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michele Jackson
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kush Kapur
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah A Kelley
- Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA
| | - Eric H W Kossoff
- Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA
| | - Yi-Chen Lai
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Tiffani L McDonough
- Division of Child Neurology, Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Mohamad A Mikati
- Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Lindsey A Morgan
- Departments of Pediatrics and Neurology, Seattle Children's Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Edward J Novotny
- Departments of Pediatrics and Neurology, Seattle Children's Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Adam P Ostendorf
- Department of Neurology, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Eric T Payne
- Department of Neurology, Mayo Clinic, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Katrina Peariso
- Division of Pediatric Neurology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Juan Piantino
- Department of Neurology, Doernbercher Children's Hospital, Oregon Health & Science University, Portland, OR, USA
| | - James J Riviello
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Kumar Sannagowdara
- Department of Pediatric Neurology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Carl E Stafstrom
- Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, MD, USA
| | - Robert C Tasker
- Department of Neurology, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dmitry Tchapyjnikov
- Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Alexis A Topjian
- Division of Critical Care Medicine, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alejandra Vasquez
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark S Wainwright
- Departments of Pediatrics and Neurology, Seattle Children's Hospital, University of Washington, and Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Angus Wilfong
- Barrow Neurological Institute, Phoenix Children's Hospital, Department of Pediatrics, University of Arizona School of Medicine, Phoenix, AZ, USA
| | - Korwyn Williams
- Barrow Neurological Institute, Phoenix Children's Hospital, Department of Pediatrics, University of Arizona School of Medicine, Phoenix, AZ, USA
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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13
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Jafarpour S, Stredny CM, Piantino J, Chapman KE. Baseline and outcome assessment in pediatric status epilepticus. Seizure 2019; 68:52-61. [DOI: 10.1016/j.seizure.2018.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022] Open
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Gurcharran K, Grinspan ZM. The burden of pediatric status epilepticus: Epidemiology, morbidity, mortality, and costs. Seizure 2019; 68:3-8. [DOI: 10.1016/j.seizure.2018.08.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/23/2018] [Accepted: 08/26/2018] [Indexed: 12/30/2022] Open
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15
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Lo WL, Leu HB, Yang MC, Wang DH, Hsu ML. Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study. J Dent Sci 2019; 14:241-247. [PMID: 31528251 PMCID: PMC6739300 DOI: 10.1016/j.jds.2019.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
Background/purpose Dysphagia was associated with increased prevalence of aspiration pneumonia (AP) in studies that were criticized for either their small sample size or lack of prospective design. Using a considerably larger nationwide, population-based database and a long-term prospective cohort design, our study aimed to explore the relationship between dysphagia and the subsequent development of AP. Materials and methods From 2000 to 2009, we gathered a study cohort consisting of 6979 newly diagnosed cases of dysphagia from Taiwan's National Health Insurance Research Database. For the control group, another 20,937 individuals without dysphagia were matched for age, sex, and comorbidity. The two cohorts were followed-up to observe the occurrence of AP and correlated mortality. Results During an average of 3.88 ± 2.73 years of follow-up, we observed 315 cases of new AP [non-dysphagia (193, 0.92%) vs. dysphagia (122, 1.75%), p < 0.0001], and the incidence of AP was significant in the dysphagia group. After adjusting for age, sex, and comorbidity, dysphagia-related AP [hazard ratio (HR) 2.499; 95% confidence interval (CI), 2.089-2.99; p < 0.0001], dysphagia related mortality [HR 3.229; 95% CI, 3.052-3.417; p < 0.0001], and many other systemic diseases were independently associated with a diagnosis of AP. Conclusion Dysphagia was highly associated with an increased risk of AP according to data derived from a large nationwide cohort database. Nonetheless, larger prospective studies or meta-analyses are recommended to confirm our findings.
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Affiliation(s)
- Wen-Liang Lo
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
- Division of Oral and Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei, 11217, Taiwan
- Corresponding author. Department of Dentistry, School of Dentistry, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, 112, Taiwan. Fax: +886 2 28742375.
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
- Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Chen Yang
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Ding-Han Wang
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Lun Hsu
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
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Sánchez Fernández I, Loddenkemper T. Estimating the cost of admissions related to convulsive status epilepticus in the United States of America. Seizure 2018; 61:186-198. [DOI: 10.1016/j.seizure.2018.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/24/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022] Open
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Sculier C, Gaínza‐Lein M, Sánchez Fernández I, Loddenkemper T. Long-term outcomes of status epilepticus: A critical assessment. Epilepsia 2018; 59 Suppl 2:155-169. [PMID: 30146786 PMCID: PMC6221081 DOI: 10.1111/epi.14515] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 11/29/2022]
Abstract
We reviewed 37 studies reporting long-term outcomes after a status epilepticus (SE) episode in pediatric and adult populations. Study design, length of follow-up, outcome measures, domains investigated (mortality, SE recurrence, subsequent epilepsy, cognitive outcome, functional outcome, or quality of life), and predictors of long-term outcomes are summarized. Despite heterogeneity in the design of prior studies, overall risk of poor long-term outcome after SE is high in both children and adults. Etiology is the main determinant of outcome, and the effect of age or SE duration is often difficult to distinguish from the underlying cause. The effect of the treatment on long-term outcome after SE is still unknown.
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Affiliation(s)
- Claudine Sculier
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Department of NeurologyErasmus HospitalFree University of BrusselsBrusselsBelgium
| | - Marina Gaínza‐Lein
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Faculty of MedicineAustral University of ChileValdiviaChile
| | - Iván Sánchez Fernández
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Department of Child NeurologyHospitalSant Joan de Déu, Universidad deBarcelonaSpain
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
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18
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Lu WY, Weng WC, Wong LC, Lee WT. The etiology and prognosis of super-refractory convulsive status epilepticus in children. Epilepsy Behav 2018; 86:66-71. [PMID: 30006260 DOI: 10.1016/j.yebeh.2018.06.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Both refractory convulsive status epilepticus (SE) and super-refractory SE are medical emergencies. However, there are limited data on super-refractory SE in children. Thus, this study focuses on characterizing the demographics, outcomes, and prognostic factors for super-refractory SE in children. METHODS This study was a retrospective analysis of super-refractory SE treated in a tertiary referral center in Taiwan. The functional outcome was evaluated by modified Rankin scale (mRS). Significant functional decline was defined as an mRS difference (before hospital admission and at discharge) of more than 2. The variates and the follow-up mRS values were then analyzed statistically. RESULTS We enrolled 134 patients with 191 episodes of convulsive SE and identified 30 patients with 38 episodes of convulsive super-refractory SE. The incidence of convulsive super-refractory SE in the group with SE was 19.9%, and the age ranged from 2.5 months to 17 years. In-hospital mortality was 13.3%, which was much lower than that of adult cohorts. Newly acquired epilepsy and cognitive deficit occurred in 100% and 88.5%, respectively. Newly acquired epilepsy, as a sequel of super-refractory SE, was observed in all 18 patients (100%) who survived and had no history of epilepsy. Significant functional decline (mRS difference of more than 2) at discharge occurred in 76.7%. Poor functional outcome was associated with acute symptomatic etiology (P < 0.001) and the number of anesthetic agents (P = 0.002). The functional outcome improved after 1 year of follow-up in our population. CONCLUSIONS Super-refractory SE is associated with significant morbidity and mortality in children. However, the in-hospital mortality rate is much lower compared with adults. The functional outcome in children is associated with acute symptomatic etiology and the number of anesthetic agents and may improve after long-term follow-up.
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Affiliation(s)
- Wen-Yu Lu
- Department of Pediatrics, Min-Sheng General Hospital, No. 168, ChingKuo Rd., Taoyuan Dist., Taoyuan City 330, Taiwan; Department of Pediatrics, National Taiwan University Hospital, No. 8, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan; Clinical Center for Neuroscience and Behavior, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan
| | - Lee-Chin Wong
- Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan; Clinical Center for Neuroscience and Behavior, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Da'an Dist., Taipei City 106, Taiwan.
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19
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Sánchez Fernández I, Goodkin HP, Scott RC. Pathophysiology of convulsive status epilepticus. Seizure 2018; 68:16-21. [PMID: 30170734 DOI: 10.1016/j.seizure.2018.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/05/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To summarize the pathophysiology of convulsive status epilepticus (SE) with a focus on practical implications for treatment. METHOD Narrative review of the medical literature on the pathophysiology of convulsive SE. We considered both animal models of SE and clinical studies. RESULTS Convulsive SE is an emergency in which prolonged convulsive seizures are associated with cardiorespiratory instability, hypoxia, hypoglycemia, and hyperthermia. Supportive treatment helps correct these physiological imbalances. When treatment is delayed, the ability of first line seizure suppressing medications to terminate the seizure can be reduced. Animal studies have suggested that GABAA receptor trafficking may contribute to the failure of the first line therapies and that NMDA receptor antagonists such as ketamine may become more effective as seizures last longer. Potential strategies to take advantage of these changes in pathophysiology include a rapid escalation from benzodiazepines to non-benzodiazepine antiepileptic drugs (AEDs), early polytherapy and use of NMDA antagonists such as ketamine for refractory convulsive SE. Despite the importance of a timely treatment of convulsive SE, major treatment delays are frequent in clinical practice. Policies to improve time to treatment, especially in convulsive SE that starts outside the hospital, may improve response to treatment and convulsive SE outcomes. CONCLUSIONS Convulsive SE is a time-sensitive emergency in which the underlying pathophysiology may provide targets for improving treatment strategies. A timely transition from benzodiazepines to other AEDs may help reduce treatment resistance in convulsive SE.
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain
| | - Howard P Goodkin
- Departments of Neurology and Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Rod C Scott
- Neurosciences Unit, University College London Great Ormond Street Institute of Child Health, London, UK; Department of Neurological Sciences, University of Vermont, Burlington, VT, United States.
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Tiamkao S, Saybungkla P, Sirikarn P, Sawanyawisuth K. Predictors of long-term mortality in status epilepticus. Epilepsy Behav 2018; 84:114-117. [PMID: 29778845 DOI: 10.1016/j.yebeh.2018.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND There were several studies that have reported on the long-term mortality rate of status epilepticus (SE). However, these studies were conducted mainly in Western countries using small study populations. This study aimed to evaluate predictors for long-term mortality in SE using the Thai national healthcare database. METHODS This study was conducted using the Thai national Universal Health Coverage (UC) database. The eligibility criteria for this study were that all patients were diagnosed with SE and had been admitted to any hospital between 2005 and 2015. Mortality was defined at discharge and at one, three, five, and 10 years. All eligible patients were categorized as either having survived or having died. The mortality rates were calculated at one, three, five, and 10 years. Factors associated with mortality were analyzed using backward multivariate Cox proportional hazard regression analysis. Kaplan-Meier was performed to estimate the survival rate. RESULTS During the study period, there were 21,732 patients with SE admitted who met the study criteria. The total observation time was 85,821.28 person-years. Of the patients enrolled, 3642 (or 4.24 per 100 person-years [95% confidence interval (CI): 4.11-4.38]) died. Factors positively associated with mortality in patients with SE were central nervous system (CNS) infection, cancer, heart diseases, chronic renal failure, septicemia, pneumonia, respiratory failure, acute renal failure, and shock. Heart diseases had the highest adjusted hazard ratio at 2.69 (95% CI: 2.47-2.93). Two factors were negatively related with SE mortality: hypertension and urinary tract infection. CONCLUSION Long-term mortality in patients with SE had both positive and negative predictors in the national database.
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Affiliation(s)
- Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Pawinee Saybungkla
- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand; Srinagarind Hospital, Faculty of Medicine, Khon kaen University, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Srinagarind Hospital, Faculty of Medicine, Khon kaen University, Khon Kaen, Thailand; Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine and Ambulatory Medicine Research Group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
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- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
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Sánchez Fernández I, Gaínza-Lein M, Abend NS, Anderson AE, Arya R, Brenton JN, Carpenter JL, Chapman KE, Clark J, Gaillard WD, Glauser TA, Goldstein JL, Goodkin HP, Helseth AR, Jackson MC, Kapur K, Lai YC, McDonough TL, Mikati MA, Nayak A, Peariso K, Riviello JJ, Tasker RC, Tchapyjnikov D, Topjian AA, Wainwright MS, Wilfong A, Williams K, Loddenkemper T. Factors associated with treatment delays in pediatric refractory convulsive status epilepticus. Neurology 2018; 90:e1692-e1701. [PMID: 29643084 DOI: 10.1212/wnl.0000000000005488] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/15/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify factors associated with treatment delays in pediatric patients with convulsive refractory status epilepticus (rSE). METHODS This prospective, observational study was performed from June 2011 to March 2017 on pediatric patients (1 month to 21 years of age) with rSE. We evaluated potential factors associated with increased treatment delays in a Cox proportional hazards model. RESULTS We studied 219 patients (53% males) with a median (25th-75th percentiles [p25-p75]) age of 3.9 (1.2-9.5) years in whom rSE started out of hospital (141 [64.4%]) or in hospital (78 [35.6%]). The median (p25-p75) time from seizure onset to treatment was 16 (5-45) minutes to first benzodiazepine (BZD), 63 (33-146) minutes to first non-BZD antiepileptic drug (AED), and 170 (107-539) minutes to first continuous infusion. Factors associated with more delays to administration of the first BZD were intermittent rSE (hazard ratio [HR] 1.54, 95% confidence interval [CI] 1.14-2.09; p = 0.0467) and out-of-hospital rSE onset (HR 1.5, 95% CI 1.11-2.04; p = 0.0467). Factors associated with more delays to administration of the first non-BZD AED were intermittent rSE (HR 1.78, 95% CI 1.32-2.4; p = 0.001) and out-of-hospital rSE onset (HR 2.25, 95% CI 1.67-3.02; p < 0.0001). None of the studied factors were associated with a delayed administration of continuous infusion. CONCLUSION Intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first BZD and the first non-BZD AED in pediatric rSE. These factors identify potential targets for intervention to reduce time to treatment.
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Affiliation(s)
- I Sánchez Fernández
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - M Gaínza-Lein
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - N S Abend
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - A E Anderson
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - R Arya
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - J N Brenton
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - J L Carpenter
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - K E Chapman
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - J Clark
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - W D Gaillard
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - T A Glauser
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - J L Goldstein
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - H P Goodkin
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - A R Helseth
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - M C Jackson
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - K Kapur
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - Y-C Lai
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - T L McDonough
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - M A Mikati
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - A Nayak
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - K Peariso
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - J J Riviello
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - R C Tasker
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - D Tchapyjnikov
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - A A Topjian
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - M S Wainwright
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - A Wilfong
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - K Williams
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix
| | - T Loddenkemper
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.G.-L., J.C., M.C.J., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, and Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Facultad de Medicina (M.G.-L.), Universidad Austral de Chile, Valdivia; Divisions of Neurology (N.S.A.) and Critical Care Medicine (A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Section of Neurology and Developmental Neuroscience (A.E.A., Y.-C.L., A.N., J.J.R.), Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston; Divisions of Neurology (R.A., K.P.) and Pediatric Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), University of Virginia Health System, Charlottesville; Center for Neuroscience (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Department of Pediatrics (T.A.G.), University of Cincinnati College of Medicine, OH; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.R.H., M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Barrow Neurological Institute (A.W., K.W.), Phoenix Children's Hospital, AZ; and Department of Pediatrics (A.W., K.W.), University of Arizona School of Medicine, Phoenix.
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22
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Outcomes in Children Treated with Pentobarbital Infusion for Refractory and Super-Refractory Status Epilepticus. Neurocrit Care 2018; 29:171-179. [DOI: 10.1007/s12028-018-0513-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Rescue Medications in Epilepsy Patients: A Family Perspective. Seizure 2017; 52:188-194. [DOI: 10.1016/j.seizure.2017.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/29/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022] Open
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Liu Z, Yu H, Guo Q. MicroRNA‑20a promotes inflammation via the nuclear factor‑κB signaling pathway in pediatric pneumonia. Mol Med Rep 2017; 17:612-617. [PMID: 29115456 DOI: 10.3892/mmr.2017.7899] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 08/22/2017] [Indexed: 11/06/2022] Open
Abstract
Pneumonia is a common respiratory disease worldwide, which is preventable and treatable; however, it is recognized as a leading cause of mortality in children. The present study aimed to investigate the role and mechanism of microRNA (miR)‑20a in inflammation in pediatric pneumonia. Clinical serum samples were collected from children with pneumonia and healthy children. Initially, the serum expression levels of miR‑20a were detected by reverse transcription‑quantitative polymerase chain reaction. Subsequently, A549 cells were randomly divided into four groups: Control group; lipopolysaccharide (LPS; 1 µg/ml) group; LPS + miR‑20a group; and LPS + miR‑20a + pyrrolidine dithiocarbamate (PDTC; 100 mmol/l) group. The concentrations of interleukin‑6 (IL‑6), tumor necrosis factor (TNF)‑α and C‑reactive protein (CRP) in clinical serum samples and A549 cells were determined by ELISA. In addition, the protein expression levels of inhibitor of nuclear factor (NF)‑κB α (IκBα) and phosphorylated (p)‑NF‑κB were measured by western blotting. The results demonstrated that miR‑20a was upregulated in children with pneumonia and in lung cells with LPS‑induced inflammatory injury (P<0.01). In addition, compared with the LPS group, cells in the LPS + miR‑20a group exhibited increased expression levels of IL‑6, TNF‑α and CRP (P<0.05). Overexpression of miR‑20a also resulted in upregulation of the expression levels of IκBα and p‑NF‑κB compared with in the LPS group (P<0.05). Furthermore, treatment with the NF‑κB inhibitor PDTC inhibited the expression of inflammatory factors compared with in the LPS + miR‑20a group (P<0.05). In conclusion, the present study indicated that miR‑20a is upregulated in pediatric pneumonia, and overexpression of miR‑20a may promote inflammation through activation of the NF‑κB signaling pathway.
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Affiliation(s)
- Zhihong Liu
- Department of Emergency, Jinan Maternity and Child Care Hospital, Jinan, Shandong 250001, P.R. China
| | - Haiying Yu
- Department of Pediatrics, Weifang People's Hospital, Weifang, Shandong 261000, P.R. China
| | - Qiuye Guo
- Department of Respiratory Medicine, Hanzhong Central Hospital, Hanzhong, Shaanxi 723000, P.R. China
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25
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Sánchez Fernández I, Jackson MC, Abend NS, Arya R, Brenton JN, Carpenter JL, Chapman KE, Gaillard WD, Gaínza-Lein M, Glauser TA, Goldstein JL, Goodkin HP, Helseth A, Kapur K, McDonough TL, Mikati MA, Peariso K, Riviello J, Tasker RC, Topjian AA, Wainwright MS, Wilfong A, Williams K, Loddenkemper T. Refractory status epilepticus in children with and without prior epilepsy or status epilepticus. Neurology 2016; 88:386-394. [PMID: 28011930 DOI: 10.1212/wnl.0000000000003550] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/19/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE). METHODS This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE. RESULTS We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.2 (1.3-9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [5-60] vs 16.5 [5-42.75] minutes, p = 0.858). Patients with a diagnosis of epilepsy received their first non-benzodiazepine (BZD) antiepileptic drug (AED) later (93 [46-190] vs 50.5 [28-116] minutes, p = 0.002) and were less likely to receive at least one continuous infusion (35/89 [39.3%] vs 57/100 [57%], p = 0.03). Compared to patients with no history of SE, patients with a history of SE received their first BZD earlier (8 [3.5-22.3] vs 20 [5-60] minutes, p = 0.0073), although they had a similar time to first non-BZD AED (76.5 [45.3-124] vs 65 [32.5-156] minutes, p = 0.749). Differences were mostly driven by the patients with an out-of-hospital rSE onset. CONCLUSIONS Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication.
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Affiliation(s)
- Iván Sánchez Fernández
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Michele C Jackson
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Nicholas S Abend
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Ravindra Arya
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - James N Brenton
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Jessica L Carpenter
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Kevin E Chapman
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - William D Gaillard
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Marina Gaínza-Lein
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Tracy A Glauser
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Joshua L Goldstein
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Howard P Goodkin
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Ashley Helseth
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Kush Kapur
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Tiffani L McDonough
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Mohamad A Mikati
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Katrina Peariso
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - James Riviello
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Robert C Tasker
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Alexis A Topjian
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Mark S Wainwright
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Angus Wilfong
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Korwyn Williams
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ
| | - Tobias Loddenkemper
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ.
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Yokochi T, Takeuchi T, Mukai J, Akita Y, Nagai K, Obu K, Kakuma T, Matsuishi T. Prediction of acute encephalopathy with biphasic seizures and late reduced diffusion in patients with febrile status epilepticus. Brain Dev 2016; 38:217-24. [PMID: 26242200 DOI: 10.1016/j.braindev.2015.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/22/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common subtype of acute encephalopathy among children in Japan. The pathogenesis of AESD is mostly delayed cerebral edema caused by excitotoxic injury. It is difficult to discriminate AESD and complex febrile seizure in the early phase. Many cases have neurologic sequelae because early intervention is difficult. METHODS To establish an early diagnostic method, we assessed 213 hospitalized cases of febrile status epilepticus (FSE) between January 2004 and August 2014. We categorized FSE cases into an AESD group and a non-AESD group and compared their clinical courses, laboratory data and cranial computed tomography (CT) findings. RESULTS Of 213 hospitalized FSE cases, 19 (9%) were AESD. Univariate analysis showed that the AESD group took a significantly longer time to wake after FSE, had a higher degree of respiratory acidemia, and higher levels of serum AST, ALT, LD, hyperglycemia and hyperammonemia than the non-AESD group. We developed a scoring model that predicts AESD based on multivariate analysis. Using cut-off points of 4 and more with this scoring model, we could identify the AESD cases with 93% sensitivity and 91% specificity. These scores also had a positive correlation with prognosis. DISCUSSION Our scoring model enables early diagnosis of AESD. Patients with high scores should be observed carefully and early intervention should be considered.
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Affiliation(s)
- Takaoki Yokochi
- Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan
| | | | - Jumpei Mukai
- Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan
| | - Yukihiro Akita
- Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan
| | - Kojiro Nagai
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Keizo Obu
- Department of Pediatrics, St. Mary's Hospital, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Center for Bio-Statistics, Kurume University School of Medicine, Fukuoka, Japan
| | - Toyojiro Matsuishi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.
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27
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Sánchez Fernández I, Abend NS, Agadi S, An S, Arya R, Brenton JN, Carpenter JL, Chapman KE, Gaillard WD, Glauser TA, Goodkin HP, Kapur K, Mikati MA, Peariso K, Ream M, Riviello J, Tasker RC, Loddenkemper T. Time from convulsive status epilepticus onset to anticonvulsant administration in children. Neurology 2015; 84:2304-11. [PMID: 25948729 DOI: 10.1212/wnl.0000000000001673] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/05/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED). METHODS This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE. RESULTS We enrolled 81 patients (44 male) with a median age of 3.6 years. The first, second, and third AED doses were administered at a median (p25-p75) time of 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes after SE onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2-3) doses of benzodiazepines were administered before switching to nonbenzodiazepine AEDs. The first and second doses of nonbenzodiazepine AEDs were administered at 69 (40-120) minutes and 120 (75-296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5-15) minutes and 16 (10-40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset). CONCLUSIONS The time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the prehospital and in-hospital settings.
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Affiliation(s)
- Iván Sánchez Fernández
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Nicholas S Abend
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Satish Agadi
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Sookee An
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Ravindra Arya
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - James Nicholas Brenton
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Jessica L Carpenter
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Kevin E Chapman
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - William D Gaillard
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Tracy A Glauser
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Howard P Goodkin
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Kush Kapur
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Mohamad A Mikati
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Katrina Peariso
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Margie Ream
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - James Riviello
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Robert C Tasker
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY
| | - Tobias Loddenkemper
- From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY.
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Maegaki Y, Kurozawa Y, Tamasaki A, Togawa M, Tamura A, Hirao M, Nagao A, Kouda T, Okada T, Hayashibara H, Harada Y, Urushibara M, Sugiura C, Sejima H, Tanaka Y, Matsuda-Ohtahara H, Kasai T, Kishi K, Kaji S, Toyoshima M, Kanzaki S, Ohno K. Early predictors of status epilepticus-associated mortality and morbidity in children. Brain Dev 2015; 37:478-86. [PMID: 25193404 DOI: 10.1016/j.braindev.2014.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/21/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early predictors of status epilepticus (SE)-associated mortality and morbidity have not been systematically studied in children, considerably impeding the identification of patients at risk. OBJECTIVES To determine reliable early predictors of SE-associated mortality and morbidity and identify the etiology of SE-associated sequelae in Japanese children. METHODS We conducted a prospective multicenter study of clinical findings and initial laboratory data acquired at SE onset, and assessed outcomes at the last follow-up examination. In-hospital death during the acute period and neurological sequelae were classified as poor outcomes. RESULTS Of the 201 children who experienced their first SE episode, 16 exhibited poor outcome that was most commonly associated with acute encephalopathy. Univariate analysis revealed that the following were associated with poor outcomes: young age (⩽24 months); seizure duration >90 min; seizure intractability (failure of the second anticonvulsive drug); biphasic seizures; abnormal blood glucose levels (<61 or >250 mg/dL); serum aspartate aminotransferase (AST) ⩾56 U/L; and C-reactive protein (CRP) levels >2.00 mg/dL. Multivariate analysis revealed that young age, seizure intractability, abnormal blood glucose levels, and elevated AST and CRP levels were statistically significant. CONCLUSIONS Young age and seizure intractability were highly predictive of poor outcomes in pediatric SE. Moreover, abnormal blood glucose levels and elevated AST and CRP levels were predictors that might be closely associated with the etiology, especially acute encephalopathy and severe bacterial infection (sepsis and meningitis) in Japanese children.
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Affiliation(s)
- Yoshihiro Maegaki
- Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Youichi Kurozawa
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Akiko Tamasaki
- Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | - Akiko Tamura
- Tottori Prefecture Central Hospital, Tottori, Japan
| | | | | | | | | | | | | | - Makoto Urushibara
- Tottori Prefecture Saiseikai Sakaiminato General Hospital, Sakaiminato, Japan
| | - Chitose Sugiura
- Tottori Prefectural Rehabilitation Center for Disabled Children, Yonago, Japan
| | | | | | | | | | - Kazuko Kishi
- Shimane University School of Medicine, Izumo, Japan
| | | | | | - Susumu Kanzaki
- Division of Pediatrics and Perinatology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kousaku Ohno
- Division of Child Neurology, Faculty of Medicine, Tottori University, Yonago, Japan
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Sánchez Fernández I, Loddenkemper T. Therapeutic choices in convulsive status epilepticus. Expert Opin Pharmacother 2015; 16:487-500. [PMID: 25626010 DOI: 10.1517/14656566.2015.997212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Convulsive status epilepticus (SE) is one of the most frequent and severe neurological emergencies in both adults and children. A timely administration of appropriate antiepileptic drugs (AEDs) can stop seizures early and markedly improve outcome. AREAS COVERED The main treatment strategies for SE are reviewed with an emphasis on initial treatments. The established first-line treatment consists of benzodiazepines, most frequently intravenous lorazepam. Benzodiazepines that do not require intravenous administration like intranasal midazolam or intramuscular midazolam are becoming more popular because of easier administration in the field. Other benzodiazepines may also be effective. After treatment with benzodiazepines, treatment with fosphenytoin and phenobarbital is usually recommended. Other intravenously available AEDs, such as valproate and levetiracetam, may be as effective and safe as fosphenytoin and phenobarbital, have a faster infusion time and better pharmacokinetic profile. The rationale behind the need for an early treatment of SE is discussed. The real-time delays of AED administration in clinical practice are described. EXPERT OPINION There is limited evidence to support what the best initial benzodiazepine or the best non-benzodiazepine AED is. Recent and developing multicenter trials are evaluating the best treatment options and will likely modify the recommended treatment choices in SE in the near future. Additionally, more research is needed to understand how different treatment options modify prognosis in SE. Timely implementation of care protocols to minimize treatment delays is crucial.
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Affiliation(s)
- Iván Sánchez Fernández
- Boston Children's Hospital, Harvard Medical School, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Fegan 9 , 300 Longwood Avenue, Boston, MA 02115 , USA
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Sánchez Fernández I, Klehm J, An S, Jillella D, Kapur K, Zelener J, Rotenberg A, Loddenkemper T. Comparison of risk factors for pediatric convulsive status epilepticus when defined as seizures ≥5min versus seizures ≥30min. Seizure 2014; 23:692-8. [DOI: 10.1016/j.seizure.2014.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 11/15/2022] Open
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Leyenaar JK, Lagu T, Shieh MS, Pekow PS, Lindenauer PK. Management and outcomes of pneumonia among children with complex chronic conditions. Pediatr Infect Dis J 2014; 33:907-11. [PMID: 24732445 PMCID: PMC4760109 DOI: 10.1097/inf.0000000000000317] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Although pneumonia is a common reason for pediatric hospitalization among children with complex chronic conditions (CCC), treatment and outcomes have not been well-described. We characterized the presentation, management and outcomes of pneumonia in children with and without CCC and described how antibiotic management and outcomes vary among subgroups of children with CCC. METHODS We conducted a cohort study of children <18 years with pneumonia across a large sample of US hospitals. Children were grouped according to CCC subgroups. Differences in disease management and outcomes were assessed using multivariable regression. RESULTS Of the 31,684 children in our cohort, 11.9% had CCC. Children with CCC were more likely to receive intensive investigations and therapies, were less likely to receive aminopenicillins or third generation cephalosporins and were more likely to receive antibiotics against methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa and anaerobes. Compared with children without these conditions, children with CCC had significantly increased length of stay [relative risk 1.43, 95% confidence interval (CI) 1.39-1.48] and hospital costs (relative risk 1.38, 95% CI 1.33-1.43), with increased odds of antibiotic escalation (odds ratio 1.51, 95% CI 1.35-1.70), pneumonia complications (odds ratio 1.47, 95% CI 1.24-1.75) and readmission (odds ratio 4.0, 95% CI 3.2-5.0). DISCUSSION Children with CCC comprise a significant proportion of children hospitalized for pneumonia and are at substantially increased risk of adverse outcomes. They have high rates of treatment with broad spectrum antibiotics, both at the time of hospitalization and subsequently. Research is needed to inform decision-making and guideline development, with goals of reducing adverse outcomes and unnecessary variation in management among children with CCC.
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Affiliation(s)
- JoAnna K Leyenaar
- From the *Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston; †Center for Quality of Care Research; ‡Division of General Internal Medicine, Baystate Medical Center, Springfield; §Department of Medicine, Tufts University School of Medicine, Boston; and ¶Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
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Raible DJ, Frey LC, Brooks-Kayal AR. Effects of JAK2-STAT3 signaling after cerebral insults. JAKSTAT 2014; 3:e29510. [PMID: 25105066 PMCID: PMC4124058 DOI: 10.4161/jkst.29510] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022] Open
Abstract
The JAK2-STAT3 signaling pathway has been shown to regulate the expression of genes involved in cell survival, cell proliferation, cell-cycle progression, and angiogenesis in development and after cerebral insults. Until recently, little has been known about the effects of this pathway activation after cerebral insults and if blocking this pathway leads to better recovery. This review exams the role of this pathway after 3 cerebral insults (traumatic brain injury, stroke, and status epilepticus).
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Affiliation(s)
- Daniel J Raible
- Neuroscience Program; University of Colorado; Anschutz Medical Campus; Aurora, CO USA
| | - Lauren C Frey
- Department of Neurology; University of Colorado School of Medicine; Aurora, CO USA
| | - Amy R Brooks-Kayal
- Neuroscience Program; University of Colorado; Anschutz Medical Campus; Aurora, CO USA ; Department of Neurology; University of Colorado School of Medicine; Aurora, CO USA ; Division of Neurology; Department of Pediatrics; University of Colorado School of Medicine; Aurora, CO USA ; Children's Hospital Colorado; Aurora, CO USA
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33
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Sánchez Fernández I, Abend NS, Arndt DH, Carpenter JL, Chapman KE, Cornett KM, Dlugos DJ, Gallentine WB, Giza CC, Goldstein JL, Hahn CD, Lerner JT, Matsumoto JH, McBain K, Nash KB, Payne E, Sánchez SM, Williams K, Loddenkemper T. Electrographic seizures after convulsive status epilepticus in children and young adults: a retrospective multicenter study. J Pediatr 2014; 164:339-46.e1-2. [PMID: 24161223 PMCID: PMC3946834 DOI: 10.1016/j.jpeds.2013.09.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/22/2013] [Accepted: 09/13/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the prevalence, characteristics, and predictors of electrographic seizures after convulsive status epilepticus (CSE). STUDY DESIGN This was a multicenter retrospective study in which we describe clinical and electroencephalographic (EEG) features of children (1 month to 21 years) with CSE who underwent continuous EEG monitoring. RESULTS Ninety-eight children (53 males) with CSE (median age of 5 years) underwent subsequent continuous EEG monitoring after CSE. Electrographic seizures (with or without clinical correlate) were identified in 32 subjects (33%). Eleven subjects (34.4%) had electrographic-only seizures, 17 subjects (53.1%) had electroclinical seizures, and 4 subjects (12.5%) had an unknown clinical correlate. Of the 32 subjects with electrographic seizures, 15 subjects (46.9%) had electrographic status epilepticus. Factors associated with the occurrence of electrographic seizures after CSE were a previous diagnosis of epilepsy (P = .029) and the presence of interictal epileptiform discharges (P < .0005). The median (p25-p75) duration of stay in the pediatric intensive care unit was longer for children with electrographic seizures than for children without electrographic seizures (9.5 [3-22.5] vs 2 [2-5] days, Wilcoxon test, Z = 3.916, P = .0001). Four children (4.1%) died before leaving the hospital, and we could not identify a relationship between death and the presence or absence of electrographic seizures. CONCLUSIONS After CSE, one-third of children who underwent EEG monitoring experienced electrographic seizures, and among these, one-third experienced entirely electrographic-only seizures. A previous diagnosis of epilepsy and the presence of interictal epileptiform discharges were risk factors for electrographic seizures.
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain
| | - Nicholas S Abend
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Daniel H Arndt
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, MI; Department of Neurology, Oakland University William Beaumont School of Medicine, Royal Oak, MI
| | | | - Kevin E Chapman
- Division of Neurology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
| | - Karen M Cornett
- Division of Pediatric Neurology, Duke University Hospital and Duke University School of Medicine, Durham, NC
| | - Dennis J Dlugos
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - William B Gallentine
- Division of Pediatric Neurology, Duke University Hospital and Duke University School of Medicine, Durham, NC
| | - Christopher C Giza
- Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joshua L Goldstein
- Division of Neurology, Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cecil D Hahn
- Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, ON
| | - Jason T Lerner
- Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joyce H Matsumoto
- Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kristin McBain
- Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, ON
| | - Kendall B Nash
- Department of Neurology, University of California San Francisco, San Francisco, CA
| | - Eric Payne
- Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, ON
| | - Sarah M Sánchez
- Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Korwyn Williams
- Department of Pediatrics, University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Sánchez Fernández I, Abend NS, Agadi S, An S, Arya R, Carpenter JL, Chapman KE, Gaillard WD, Glauser TA, Goldstein DB, Goldstein JL, Goodkin HP, Hahn CD, Heinzen EL, Mikati MA, Peariso K, Pestian JP, Ream M, Riviello JJ, Tasker RC, Williams K, Loddenkemper T. Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure 2013; 23:87-97. [PMID: 24183923 PMCID: PMC6387832 DOI: 10.1016/j.seizure.2013.10.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/07/2013] [Accepted: 10/09/2013] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Status epilepticus (SE) is a life-threatening condition that can be refractory to initial treatment. Randomized controlled studies to guide treatment choices, especially beyond first-line drugs, are not available. This report summarizes the evidence that guides the management of refractory convulsive SE (RCSE) in children, defines gaps in our clinical knowledge and describes the development and works of the 'pediatric Status Epilepticus Research Group' (pSERG). METHODS A literature review was performed to evaluate current gaps in the pediatric SE and RCSE literature. In person and online meetings helped to develop and expand the pSERG network. RESULTS The care of pediatric RCSE is largely based on extrapolations of limited evidence derived from adult literature and supplemented with case reports and case series in children. No comparative effectiveness trials have been performed in the pediatric population. Gaps in knowledge include risk factors for SE, biomarkers of SE and RCSE, second- and third-line treatment options, and long-term outcome. CONCLUSION The care of children with RCSE is based on limited evidence. In order to address these knowledge gaps, the multicenter pSERG was established to facilitate prospective collection, analysis, and sharing of de-identified data and biological specimens from children with RCSE. These data will allow identification of treatment strategies associated with better outcomes and delineate evidence-based interventions to improve the care of children with SE.
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Affiliation(s)
- Iván Sánchez Fernández
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Spain
| | - Nicholas S Abend
- Division of Neurology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Satish Agadi
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Sookee An
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Jessica L Carpenter
- Department of Epilepsy, Neurophysiology, and Critical Care Neurology, The Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Kevin E Chapman
- Department of Pediatrics and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - William D Gaillard
- Department of Epilepsy, Neurophysiology, and Critical Care Neurology, The Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Tracy A Glauser
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - David B Goldstein
- Center for Human Genome Variation, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Joshua L Goldstein
- Division of Neurology, Department of Pediatrics, Ann & Robert Lurie's Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Howard P Goodkin
- Department of Neurology and Department of Pediatrics, The University of Virginia Health System, Charlottesville, VA, United States
| | - Cecil D Hahn
- Division of Neurology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Erin L Heinzen
- Center for Human Genome Variation, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Mohamad A Mikati
- Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Katrina Peariso
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - John P Pestian
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States
| | - Margie Ream
- Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, United States
| | - James J Riviello
- Division of Pediatric Neurology, Department of Neurology, New York University Langone Medical Center, New York University School of Medicine, New York, NY, United States
| | - Robert C Tasker
- Department of Neurology, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Korwyn Williams
- Division of Pediatric Neurology, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
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