Status epilepticus in children: aetiology, treatment, and outcome

Abstract

This retrospective study includes 65 children treated for status epilepticus at Tampere University Hospital in Finland. Aetiology of the condition, effectiveness of the treatment protocol, including short barbiturate anaesthesia to prevent prolonged status epilepticus episodes, and neurological outcome were evaluated. Symptomatic aetiology was present in 40% of status epilepticus episodes, and 37% of episodes were induced by fever. Neurological sequelae secondary to status epilepticus were identified in 15% of the cases and subsequent epilepsy in 23% during the mean follow‐up time of 3.6 years. There were no status epilepticus‐related deaths. The cut‐off point of status epilepticus duration for significant risk for permanent neurological sequelae was 2 hours. Our treatment protocol, including short barbiturate anaesthesia in refractory cases, was able to abort status epilepticus in less than 2 hours in 75% of cases. We conclude that early and prompt use of barbiturate anaesthesia should be encouraged, and may explain our low morbidity figures.

Frequency, Etiology and Immediate Outcome of Children Admitted to Pediatric Intensive Care Unit (Picu) With Convulsive Status Epi Lepticus in Kashmir North India

“…20 and Finland. 21 No child died in the study from Finland, four children (2.2%) developed permanent neurological sequelae. In contrast, an earlier 10-year study from the USA undertaken in 147 children (Aged three days to 18 years) admitted in status to a PICU found that nine patients (6%) died on PICU, usually due to the underlying cause of the status, rather than the status itself.…”

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

“…These findings have been reproduced in studies that have specifically assessed refractory seizures [14,28,29] and in studies where prolonged seizures or PICU admission were the only inclusion criteria [15,27,32,34,35]. Although improved outcomes have been associated with febrile CSE [35], developmental deficits are still demonstrable on follow up compared to controls.…”

“…In studies which examined both refractory and non-refractory CSE, the reported prevalence of de novo epilepsy varied from 5.1% [21] to 30% [6,28,32,33] and new neurological sequelae from 2.2% to 29.8% [5,[32][33][34][35].…”

“…There is some evidence that aetiology is a risk factor independent of seizure duration [34]. Where aetiology was not controlled for, duration of seizure has been suggested as an independent factor [32].…”

Status Epilepticus

“…The more widely acceptable definition is seizure (clinical or electrographic) persisting despite failure of two or more anticonvulsants. Epidemiological studies in children have suggested that SE lasted >1 h in 26-45%, >2 h in 17-25%, and >4 h in 10% [41][42][43]. These children usually require aggressive management in pediatric intensive care unit and evaluation by a pediatric neurologist.…”