In Whom Does Status Epilepticus Occur: Age‐Related Differences in Children

Shinnar, Shlomo; Pellock, John M.; Moshé, Solomon L.; Maytal, Joseph; O’Dell, Christine; Driscoll, Susan M.; Alemany, Marta; Newstein, David; DeLorenzo, Robert J.

doi:10.1111/j.1528-1157.1997.tb01256.x

Cited by 182 publications

(144 citation statements)

References 32 publications

(66 reference statements)

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“…One of the best prognostic factors of SE is etiology, and the highest mortality rates are observed in patients with acute symptomatic or progressive symptomatic etiologies. Mortality rates in acute symptomatic SE range from 27 to 34% 2, 4,10,11,22 , which are lower than our findings (53%). Other etiologies, such as febrile SE, are associated with lower mortality rates, from 0 to 3% 9,10,11,14 .…”

Section: Discussioncontrasting

confidence: 56%

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Short-term mortality and prognostic factors related to status epilepticus

Stelzer

Bustamante

Sander

et al. 2015

Arq. Neuro-Psiquiatr.

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Epileptic seizures are self-limited, lasting, in general, less than to 2 minutes. Status epilepticus (SE) is manifested by continuous or recurrent epileptic seizures without full recovery of motor, sensory and/or cognitive functions, and has multiple etiologies and a diverse prognosis. The duration of seizures in SE varies from 5 to 30 minutes, depending on the definition 1 . It is one of the most frequent neurological emergencies, with an estimated annual incidence of from 6.2 to 61/100,000 people 2,3 . SE is associated with long-term mortality that is nearly three times greater than that of the general population 4 . Indeed, despite new advances in medical treatment, short-term mortality remains high, ranging from 3 to 40%, depending on the sampling methods, age, specific etiology, or refractoriness of SE .Several studies agree that the most important factors related to mortality in SE are older age, acute symptomatic etiology such as central nervous system (CNS) infection, acute stroke, metabolic disturbances, and anoxia, and long seizure duration. Anti-epileptic drug (AED) withdrawal in previously epileptic patients is typically associated with low mortality 2,6 . For other characteristics, such as gender, history of prior epilepsy, refractory SE, adequacy of medical treatment, presence of medical complications, level of consciousness, and electroencephalographic pattern, there is no consensus in the literature 2 . A better understanding of SE prognostic factors would assist in making treatment-related decisions. AbStrActObjective: Status epilepticus (SE) is associated with significant morbidity and mortality, and there is some controversy concerning predictive indicators of outcome. Our main goal was to determine mortality and to identify factors associated with SE prognosis. Method: This prospective study in a tertiary-care university hospital, included 105 patients with epileptic seizures lasting more than 30 minutes. Mortality was defined as death during hospital admission. Results: The case-fatality rate was 36.2%, which was higher than in previous studies. In univariate analysis, mortality was associated with age, previous epilepsy, complex focal seizures; etiology, recurrence, and refractoriness of SE; clinical complications, and focal SE. In multivariate analysis, mortality was associated only with presence of clinical complications. Conclusions: Mortality associated with SE was higher than reported in previous studies, and was not related to age, specific etiology, or SE duration. In multivariate analysis, mortality was independently related to occurrence of medical complications.Keywords: status epilepticus, epilepsy, mortality, prognosis. reSumo Objetivos: Status epilepticus (SE) está associado com morbidade e mortalidade importantes. Diversos estudos avaliaram determinantes de prognóstico relacionados com SE, havendo controvérsias neste sentido. O objetivo deste estudo foi avaliar mortalidade no SE e seus fatores determinantes. Método: Estudo prospectivo, em Ribeirão Preto, incluiu 105 pacientes...

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Section: Discussioncontrasting

confidence: 56%

“…SE etiology was classified as follows 8,9,10,11 : • Acute symptomatic: SE occurring during within 7 days of an acute disease, such as CNS infection, brain trauma, cerebrovascular disease, toxic or metabolic insults.…”

Section: Methodsmentioning

confidence: 99%

Short-term mortality and prognostic factors related to status epilepticus

Stelzer

Bustamante

Sander

et al. 2015

Arq. Neuro-Psiquiatr.

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“…The etiology is highly age dependent in the pediatric age group. Fever and infection are the most common causes of GCSE in children younger than 2 years of age without a history of epilepsy; however, preexisting epilepsy and low AED levels remain common causes in older children, and appropriate attention to AED levels is warranted (14,16).…”

Section: Risk Factors For Occurrence Of Gcsementioning

confidence: 99%

“…This is probably because of the resilient nature of children's physiology and the nature of the etiologies that occur in this population. Mortality rate is dependent on age and etiology, which are intricately linked (14,16). The most common etiology in young children is infection with fever, which carries a low mortality rate.…”

Section: Risk Factors For Mortality Of Gcsementioning

confidence: 99%

Status Epilepticus: Risk Factors and Complications

2000

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Summary: Status epilepticus is common and associated with significant mortality and complications. It affects approximately 50 patients per 100,000 population annually and recurs in >13%. History of epilepsy is the strongest single risk factor for generalized convulsive status epilepticus. More than 15% of patients with epilepsy have at least one episode of status epilepticus and low antiepileptic drug levels are a potentially modifiable risk factor. Other risks include young age, genetic predisposition, and acquired brain insults. Fever is a very common risk in children, as is stroke in adults. Mortality rates are 15% to 20% in adults and 3% to 15% in children. Acute complications result from hyperthermia, pulmonary edema, cardiac arrhythmias, and cardiovascular collapse. Long‐term complications include epilepsy (20% to 40%), encephalopathy (6% to 15%), and focal neurologic deficits (9% to 11%). Neuronal injury leading to temporal lobe epilepsy is probably mediated by excess excitation via activation of the N‐methyl‐D‐aspartate (NMDA) subtype of glutamate receptors and consequent elevated intracellular calcium that causes acute necrosis and delayed apoptotic cell death. Some forms of nonconvulsive status epilepticus may also lead to neuronal injury by this mechanism, but others may not. Based on clinical and experimental observations, complex partial status epilepticus is more likely to result in neuronal injury similar to generalized convulsive status epilepticus. Absence status epilepticus is much less likely to result in neuronal injury, and complications because it may be mediated primarily through excess inhibition. Future research strategies to prevent complications of status epilepticus include the study of new drugs (including NMDA antagonists, new drug delivery systems, and drug combinations) to stop seizure activity and prevent acute and delayed neuronal injury that leads to the development of epilepsy.

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“…Datos de 5 grandes cohortes muestran que recurren un tercio de los pacientes y el riesgo de desarrollar epilepsia después de una primoconvulsión febril es un 1-2%, levemente superior al de la población general 4,5 . En ninguna se ha descrito daño neurológico secundario, aún cuando la presentación fue un status febril 6,7 y la mortalidad, que teóricamente pudiera ocurrir, no se ha reportado aún 8 .…”

Section: Introductionunclassified

Recurrencia de crisis febriles en una población chilena

Pizarro

Borja

H³

et al. 2008

Rev. chil. pediatr.

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Febrile seizures recurrence in Chilean childrenObjective: Evaluate the clinical presentation and risk factors for recurrence of first febrile seizure (FS) in patients at Pediatric Emergency Department or Neurology Units at Clinical Hospital Universidad Católica (UC) and Hospital Herminda Martin from Chillán (HM). Method: Descriptive-observational study of children with age average of 2.9 years-old, with first febrile seizure between January 1, 2003 and December 31, 2005. Results: Total 158 patients; 76% presented a simple FS and 24% a complex FS as first episode, only 1 case with febrile epileptic status. In 22% and 18% respectively, there was a FS history and epilepsy in first degree relatives. 34% of patients presented a second episode; 36% of these cases present a third FS and 9% more than 3 episodes. The average time of recurrence was 6.9 months. The most important risk factors for recurrence were: epilepsy history in first degree relatives and type of febrile seizure, with hazard ratio of 2.5 (p = 0.001) and 1,8 (p = 0.03) respectively. When fitting both variables, only family history of epilepsy was significant. Conclusions: Most of FS episodes are simple and 34% present recurrence. Family history of epilepsy and type of febrile seizure are associated recurrence risk factors. The follow-up of these patients does not predict their future risk of epilepsy.

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In Whom Does Status Epilepticus Occur: Age‐Related Differences in Children

Cited by 182 publications

References 32 publications

Short-term mortality and prognostic factors related to status epilepticus

Short-term mortality and prognostic factors related to status epilepticus

Status Epilepticus: Risk Factors and Complications

Recurrencia de crisis febriles en una población chilena

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