Clinico-Etiological Profile of Pediatric Refractory Status Epilepticus at a Public Hospital in India

Abstract

Background and Purpose Refractory status epilepticus (RSE) has been infrequently studied in Indian children. This research was conducted to study the clinico-etiological profiles and short-term outcomes of children aged 1 month to 12 years with convulsive RSE, at a public hospital. Methods The study was conducted between 1st April 2016 and 28th February 2017 after receiving clearance from an Institutional Ethics Committee. All children (aged 1 month to 12 years) who presented to the pediatrics department of a tertiary-care public hospital with convulsive status epilepticus (SE), or who developed SE during their hospital stay, were enrolled. All patients were investigated and managed according to a standard protocol. Outcomes were assessed based on the Glasgow Outcome Scale. Details of children who progressed to RSE were compared to those without RSE. Results Fifty children (28 males) with CSE were enrolled, of which 20 (40%) progressed to RSE. Central nervous system (CNS) infection was the most common etiology (53% in SE and 55% in RSE, p > 0.05). Non-compliance with anti-epileptic drugs was the second most common etiology. The overall mortality rate was 38%, and although the odds of death in RSE (50%) were higher than in SE (30%), this difference was not statistically significant ( p = 0.15). The odds of having a poor outcome was six times higher in children with RSE as compared to those with SE (odds ratio, 6.0; 95% confidence interval, 1.6–22.3; p = 0.005). Conclusions When managing CNS infections, pediatricians need to be aware of the high risk of developing RSE. In addition, the possibility of RSE should be considered and managed promptly in an intensive-care setting, to reduce the mortality and morbidity of this severe neurological condition.

Clinical Feature and Outcome of Childhood Status Epilepticus in a Teaching Hospital, Odisha, India

“…The mortality rate in the present study was similar to other Indian studies [21,22], whereas studies from developed countries reported comparatively less mortality (9-24%) [23,24]. The risk factors for mortality in the present study included longer duration of SE, acute symptomatic etiology, delay in receiving first AED, RSE, the requirement of ventilator support, and circulatory impairment.…”

“…We have found that acute causes of SE trend toward the worse outcome. Duration of SE is the only potentially modifiable determinant of mortality [21]. Therefore, besides improvisation of peripheral institutes in critical care, need for high-end ambulances to transport children with SE should be the futuristic goal of the government.…”

The predictive factors for prolonged seizures and status epilepticus: a single center study

“…Abnormalities were detected in 22.5% but none required surgical intervention. In the study by Sadik et al, 72% of the patients underwent neuroimaging, with abnormalities detected in 22.8% of them (54) . In the series of Şahin et al, 20 of 45 convulsive patients underwent CT imaging, and 55% had abnormalities, while 23 patients were examined using cranial MRI, with pathological findings detected in 78.2% of them (55) .…”

Childhood Status Epilepticus: Current Status and Future Directions

“…SE has significant morbidity and mortality (29%), which is influenced majorly by the etiology and the management. Given the lack of information on etiology and outcome of SE in children from India, the study by Chetan, et al [2] in this issue of Indian Pediatrics is a welcome addition to the literature on the topic [3,4].…”