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Recurrent status epilepticus in children
S Shinnar1, J Maytal, L Krasnoff
1Department of Neurology, Albert Einstein College of Medicine, Bronx, NY.
Insights
Recurrent status epilepticus (SE) is a significant risk for children, particularly those with neurological abnormalities or remote symptomatic causes. Neurologically impaired children face a substantially higher risk of repeat SE episodes.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pediatrics
Background:
- Status epilepticus (SE) is a critical neurological emergency.
- Limited data exists on the recurrence risk of SE in pediatric populations.
- Understanding recurrence factors is vital for patient management and prognosis.
Purpose of the Study:
- To prospectively evaluate the risk of recurrent status epilepticus in children after an initial episode.
- To identify risk factors associated with SE recurrence in pediatric patients.
- To analyze the causes and outcomes of recurrent SE in children.
Main Methods:
- Prospective follow-up of 95 children experiencing their first episode of status epilepticus.
- Classification of SE causes: idiopathic, febrile, acute symptomatic, remote symptomatic, and progressive neurological disorder.
- Mean follow-up duration of 29.0 months (range 4-60 months).
Main Results:
- 17% of children experienced at least one recurrent episode of status epilepticus.
- Recurrence risk varied significantly by etiology: 4% (idiopathic), 3% (febrile), 11% (acute symptomatic), 44% (remote symptomatic), and 67% (progressive neurological disorder).
- Neurologically abnormal children had a significantly higher risk (88%) of recurrent SE compared to neurologically normal children (p < 0.001).
Conclusions:
- The risk of recurrent status epilepticus in children is influenced by the underlying cause, with remote symptomatic and progressive neurological disorders posing the highest risks.
- Children with pre-existing neurological abnormalities are at a substantially increased risk for recurrent SE.
- While SE recurrence can occur even with antiepileptic drug treatment, overall morbidity and mortality appear low.
Abstract:
Status epilepticus is an uncommon but life-threatening seizure. Little is known about the risk of recurrent status epilepticus in patients who present with an initial episode. To determine the risk of recurrent status epilepticus in children, we prospectively followed 95 children, identified at the time of their first episode of status epilepticus, for a mean of 29.0 months (range, 4-60 months). The patients' ages ranged from 1 month to 18 years (mean, 4.6 years). The cause of the status epilepticus was classified as idiopathic (n = 24), remote symptomatic (n = 18), febrile (n = 29), acute symptomatic (n = 18), or progressive neurological disorder (n = 6). Sixteen children (17%) had at least 2 episodes of status epilepticus. The risk of recurrent status was 4% (n = 1) in the idiopathic group, 44% (n = 8) in the remote symptomatic group, 3% (n = 1) in the febrile group, 11% (n = 2) in the acute symptomatic group, and 67% (n = 4) in those with progressive neurological disease. Recurrent status epilepticus occurred primarily in neurologically abnormal children. While neurologically abnormal children accounted for 34% (n = 32) of all children with status epilepticus, they comprised 88% (n = 14) of the children with recurrent status epilepticus (p less than 0.001) and all 5 of the children with multiple (greater than or equal to 3) episodes of status (p less than 0.001). Fifteen of 16 children with recurrent status epilepticus were being treated with antiepileptic drugs at the time of recurrence. The morbidity and mortality of status epilepticus were low.(ABSTRACT TRUNCATED AT 250 WORDS)