Admissions to paediatric intensive care units (PICU) with refractory convulsive status epilepticus (RCSE): A two-year multi-centre study

Tully, Ian; Draper, Elizabeth S; Lamming, CR; Mattison, Donald R.; Thomas, Charlene; Martland, Tim; Appleton, Richard

doi:10.1016/j.seizure.2015.04.002

Cited by 17 publications

(11 citation statements)

References 74 publications

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“…Excluding 1 study judged to be low quality (confined to cases of suprarefractory SE) did not significantly change the mortality (20%; 95% CI, 8.1%-31.9%; I 2 = 94.1%). In addition, there were 2 pediatric studies of RSE, one covering 2008 to 2009 with an overall mortality of 4.0% 68 and the other from 2011 to 2016 with an overall mortality of 4.7%. 69 There was no significant evidence of a small-study effect from the Egger test results (5.39; 95% CI, −2.38 to 13.16; P = .11; eFigure 12 in the Supplement).…”

Section: Refractory Sementioning

confidence: 99%

Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time

et al. 2019

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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,

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Section: Refractory Sementioning

confidence: 99%

Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time

et al. 2019

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“…A consistent finding across multiple studies is that the highest incidence of SE and refractory SE (RSE) is among children under 2 years of age. [1,[6][7][8][9][10] This may be due to a higher rate of symptomatic causes of SE, the natural course of genetic/metabolic diseases, or an increased susceptibility to seizures in the developing brain [11,12].…”

Section: Incidencementioning

confidence: 99%

“…When children with SE continue to have seizures despite two appropriate antiepileptic drugs, it is called refractory SE (RSE), which is covered in depth elsewhere in this volume [83]. The incidence of RSE ranges from 12 to 40% of all cases of SE [9,28] RSE that continues for 24 h or more after hospitalization is often called "super refractory SE" [28] or "malignant SE" [29]. Super refractory SE is uncommon, occurring in 10-15% of all cases of SE admitted to the hospital [28].…”

Section: Response To Treatmentmentioning

confidence: 99%

The burden of pediatric status epilepticus: Epidemiology, morbidity, mortality, and costs

Gurcharran

Grinspan

2019

Seizure

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To summarize the epidemiology, morbidity, mortality, and costs of status epilepticus (SE) in the pediatric population. Method: Review of the medical literature. Results: The overall incidence of pediatric SE is roughly 20 per 100,000 children per year, with overall mortality of 3%. Underlying etiology is the biggest risk factor for SE, with symptomatic (acute > remote) etiologies associated with worse outcomes. The most common cause of SE in children is febrile SE, though this entity occurs primarily in early childhood. After a first episode, the risk of recurrence is similar to the risk after a first unprovoked seizure (25-40%). SE is expensive, regularly costing more than $10,000 per episode and often more than $100,000 for refractory cases. Conclusion: SE is not an uncommon neurologic emergency and depending on the associated etiology can carry significant morbidity, mortality, and cost especially if treatment is not performed in a timely manner.

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“…Different results are presented in the literature about the etiology of SE, according to age groups, the origin of the reports, and the classification of etiology [13]. Tully et al showed that prolonged febrile seizure was most common at 1-5 years, and remote symptomatic seizure was most common at 5-10 years [14]. In other studies, whereas febrile or acute symptomatic causes were frequently seen under two years of age, remote symptomatic seizures were more common in children two years and older [1,15].…”

Section: Se Is the Most Common Neurological Emergency Of Childhood And Requires The Appropriate Administration Of Aeds For Prompt Controlmentioning

confidence: 99%

The effect of early midazolam infusion on the duration of pediatric status epilepticus patients

Ulusoy

Duman

Türker

et al. 2019

Seizure

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Status epilepticus is one of the most common neurological emergencies in pediatric emergency departments. Although there are different approaches to treatment in the literature, early control of seizure activity is the most important factor determining prognosis. The purpose of this study was to evaluate the effect of early midazolam infusion on seizure duration. Method: This retrospective study included 150 episodes of 135 patients aged one month to 18 years old with status epilepticus. All patients were treated according to the local hospital protocol for SE, which included early midazolam infusion. Demographic data, medical history, applied treatments during SE, and seizure durations were recorded. Results: The median age of the patients (58.7% male) was 2.7 years (1.0-6.0 years). The most common identified etiologies were remote symptomatic etiologies, and generalized tonic-clonic seizure was the most common seizure type. The pediatricians had selected intravenous midazolam for 130 patients (86.7%) as the first-line therapy in emergency services. In 55 patients given continuous midazolam infusion, the cumulative bolus of midazolam was 0.5 mg/kg (0.4-0.7 mg/kg), and the median peak rate of midazolam infusion was 0.2 mg/kg/h (0.2-0.4 mg/kg/h). The median duration between the start of midazolam infusion and the complete cessation of SE was 15.0 min (9.0-25.0 min). The early-midazolam infusion group had shorter seizure duration after initiation of midazolam infusion (p = 0.020). Conclusion:The current study shows that aggressive management of SE with early initiation of midazolam infusion was associated with a shorter seizure duration in SE patients.

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Admissions to paediatric intensive care units (PICU) with refractory convulsive status epilepticus (RCSE): A two-year multi-centre study

Abstract: Thiopentone was the most commonly used anticonvulsant to treat RCSE on admission to PICU. Mortality was low and approximately 1 in 25 showed a new neurological deficit at the 30-day follow-up.

Cited by 17 publications

References 74 publications

Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time

Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time

The burden of pediatric status epilepticus: Epidemiology, morbidity, mortality, and costs

The effect of early midazolam infusion on the duration of pediatric status epilepticus patients

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