Outcome of severe refractory status epilepticus in children

Refractory status epilepticus (RSE) is the persistence of seizure activity despite appropriate therapy; it is treated with high-dose suppressive anesthetic agents. We report here the outcome of RSE in a large series of children.

We retrospectively reviewed cases of RSE treated at Children's Hospital, Boston, between 1992 and 2000. Factors evaluated included age, history of seizures or neurologic impairment, etiology, outcome, including mortality or return to baseline, and initial EEG findings.

Twenty-two patients ages 4.5 months to 18 years were admitted to the intensive care unit for RSE. All were treated with high-dose suppressive therapy consisting of pentobarbital, midazolam, propofol infusion, or high-dose phenobarbital, either alone, or in combination, for < or =146 days. The overall mortality was seven of 22. Mortality was related to etiology, age, and EEG findings. No death occurred in the remote symptomatic group, and three of four younger than 3 years died, whereas only four of 18 older than 3 years died. The mortality rate among patients with focal abnormalities on the EEG was lower than that among those with multifocal or generalized abnormalities. None of the children with normal premorbid neurologic status returned to baseline.

Our data demonstrate a high mortality and morbidity for childhood RSE. Mortality is related to etiology and is higher in younger children and with multifocal or generalized abnormalities on the initial EEG.