Investigators from Rady Children's Hospital of San Diego, CA, reviewed records from all 217 children enrolled in the California Encephalitis Project 2004-2011. At least one seizure was observed clinically or recorded on EEG in 100 (46%) children. Diffuse slowing occurred in 88.9%, focal abnormalities in 63.2%, and epileptiform abnormalities in 57.3%. Continuous EEG for at least 1 day in 54 (25%) patients recorded a seizure in more than half of patients. In 22 (10%) children, a seizure was recorded by continuous EEG after routine EEG had failed to record a seizure. Overall, a continuous EEG was more likely to capture a seizure, capture a subclinical seizure, or rule out an event as a seizure than routine EEG (p < 0.0001). 
COMMENTARY. Continuous EEG is an important diagnostic tool in the ICU, to identify nonconvulsive seizures or status epilepticus, aid in management of AED treatment, and to identify seizures in children with suspected encephalitis. An online survey of pediatric neurologists from 50 US and 11 Canadian institutions conducted in 2011 found the following common cEEG indications: altered mental status after status epilepticus (97%), altered mental status of unknown cause (88%). Median number of patients with cEEG per month per center increased from 6 per month in 2010 to 10 per month in 2011 in the US .