Assessment of State of Convulsive Child in Hospital National Children Albert Royer, Dakar

Abstract

Introduction: The state of epilepticus in children is considered as a medical emergency which involves the vital and functional prognosis of the patient. The difficulties of this support in our country are linked to the lack of pediatric intensive care unit. The aim of our study is to evaluate the clinical, therapeutic, scalable and etiological states of epilepticus in children at Hospital Albert Royer National Children, Dakar.Methods: This is a prospective study which includes all patients aged between 2 months and 16 years who were hospitalized between 1 August, 2014 and 31 May, 2015 for a prolonged convulsion over 5 minutes and/or with at least 3 episodes of successive convulsions. We have not included the newborns and non-convulsive state epilepticus patients. The treatment protocol consists of the use of diazepam as first line, after 60 minutes if the crisis persists; diazepam phenobarbital was associated with the second line. Results:We collected 53 cases of state epilepticus (29 boys and 24 girls), which turned out to be a hospital incidence of 4.2%. The mean age was 48.5 months. Three quarters of our patients (n=40) were received emergency beyond 30 minutes after the onset of convulsions where the generalized seizures (n=42) were more common than partial seizures (n=11). The convulsions occurred in a context of fever in 38 patients. The metabolic balance was in favor of hyponatremia in 13 cases. Twenty-four patients (45.3%) have received only phenobarbital diazepam combination within 60 minutes after the onset of seizures. Conclusions:The state epilepticus cases are frequent in the hospital emergency department especially for infants from 2 months to 3 years. It was observed that the patients unfortunately received emergency in late beyond 30 minutes after the onset of convulsions.

Predictors of in-hospital mortality among patients with status epilepticus in Lubumbashi, Democratic Republic of the Congo: A retrospective study

“…Several factors are involved that increase the morbidity and mortality of SE, including delayed presentation to the hospital, ineffective management, and lack of awareness of the condition [5,19]. In Senegal, patients received after 30 minutes were a factor associated with mortality [21], while in Cameroon, death was associated with meningitis [22]. The prolonged duration of seizures (> 30 minutes) is associated with an increased mortality in SE due to these pathophysiological mechanisms including metabolic resource depletion, failure of cerebral autoregulation, cerebral hypoxia, disseminated intravascular coagulation, and metabolic acidosis, which can damage nerve cells and lead to organ failure, increasing the risk of death.…”