Retrospective review of pediatric status epilepticus in 116 Saudi patients: predictors of outcome

Abstract

BACKGROUNDStatus epilepticus (SE) is a common, life-threatening condition. Multiple factors are used to predict its outcome and evaluate its risks, and there have been only a few studies in Saudi Arabia.OBJECTIVESInvestigate predictors of SE outcome.DESIGNRetrospective chart review study.SETTINGTertiary center, Riyadh.PATIENTS AND METHODSWe reviewed all pediatric cases (age 14 years or younger) of SE admitted between January 2005 and December 2015, collecting data on age, sex, date of birth, developmental status, pre-existing neurological diseases, SE etiology, Glasgow Outcome Scale (GOS) scores, and electroencephalogram (EEG) findings. The outcome was categorized as poor based on any decrease in baseline GOS score or moderate-to-severe developmental delay in young children; otherwise outcome was considered good.MAIN OUTCOME MEASUREOutcome of SE.RESULTSOne hundred and sixteen patients (54% boys) with ages from 1 month to 10 years were included in the analysis. Fifty-five (47.4%) had a poor outcome. The overall mortality rate related to SE was 2.6%. Four patients had an SE duration of more than 24 hours. Univariate and multivariate analysis revealed that poor outcome was related to symptomatic SE etiology and a history of epilepsy. Age, sex, SE duration, and EEG findings were not predictors of poor outcome.CONCLUSIONPediatric status epilepticus is highly associated with neurological morbidity. The main predictor of outcome is underlying symptomatic etiology of SE and to a lesser degree the presence of a history of epilepsy. Duration does not seem to play a major role.LIMITATIONSThe main limitation is the retrospective chart review nature of the study with possible bias.

Disability and Mortality in Convulsive Status Epilepticus in Children at 3 Months' Follow-Up: A Prospective Study from India

“…have been listed as predictors of poor outcome. 6,[15][16][17][18][19] In the present study, female gender, SE duration > 1 hour before presentation, generalized onset seizures, need for critical care support, poor response to initial antiepileptic therapy, and acute symptomatic etiology were found as predictors of poor outcome.…”

The etiology and risk factors of convulsive status epilepticus in pediatric patients of tertiary center in Saudi Arabia

“…28,29 This result differs from the previous Saudi study in KAMC, which showed no difference between males and females. 11 Further, SE incidence was more prominent among children of non-Saudi origin than those of Saudi origin. Ethnic origin as a causative factor of epilepsy was also found in an American study, which demonstrated that the non-Hispanic black population's mortality rate was higher than that of the Hispanic population.…”

“…This difference is attributed to the fact that referral centers usually have a low number of febrile SE as KAMC. 11 In a Japanese study, children below the age of 15 )49.3%( were found to be affected by SE due to febrile seizure; 7 on the other hand, other European research studies have shown that the occurrence of SE can be attributed to cerebrovascular pathology )34-60%(. 18,19 In another study, 17% of the total included SE cases were caused either due to metabolic disorder or CNS infection.…”

Therapeutic hypothermia for pediatric refractory status epilepticus May Ameliorate post-status epilepticus epilepsy

“…Several studies have shown that patients with short SE durations have better outcomes [ [36] , [37] , [38] , [39] ] owing to fewer SE-related complications, such as tachycardia, hypoglycemia, hypotension, or rhabdomyolysis, although a few studies yielded inconclusive results [ 40 ]. Patients with acute symptomatic SE have a three-fold greater risk of developing chronic epilepsy compared to patients with acute symptomatic seizures [ 1 ].…”