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Published on: April 5, 2011
Features predicting adverse outcomes of status epilepticus in childhood
1Department of Paediatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong. maksk@ha.org.hk
Insights
Predicting outcomes in childhood status epilepticus is crucial. Factors like symptomatic etiology and refractory seizures indicate poor prognosis, while prompt pre-hospital treatment improves results.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Epileptology
Background:
- Status epilepticus (SE) in children is a medical emergency with potential for significant morbidity.
- Identifying predictors of adverse neurodevelopmental outcomes is essential for timely intervention.
Purpose of the Study:
- To identify clinical variables that predict abnormal neurodevelopmental outcomes in pediatric patients experiencing status epilepticus.
Main Methods:
- Retrospective study conducted at a regional hospital in Hong Kong.
- Analysis of neurodevelopmental outcomes in children under 15 admitted to the pediatric intensive care unit with status epilepticus (1997-2002).
Main Results:
- Mortality rate was 8% (2 of 25 patients), with no deaths directly attributed to status epilepticus.
- Neurological deterioration occurred in 26% of survivors.
- Symptomatic etiology and refractory status epilepticus were significantly associated with adverse outcomes (P<0.05).
- Younger age (<12 months) and longer duration (>60 minutes) of status epilepticus were more frequent in those with adverse outcomes.
Conclusions:
- Children with status epilepticus and prior normal neurodevelopmental status, without acute CNS insults or progressive encephalopathy, generally have favorable outcomes.
- Encouraging prompt administration of rectal diazepam or buccal midazolam by caretakers/paramedics is recommended to improve outcomes.
Objective:
To examine variables that might predict abnormal outcome of status epilepticus among children.
Design:
Retrospective study.
Setting:
Regional hospital, Hong Kong.
Patients:
All children younger than 15 years who were admitted to the paediatric intensive care unit with status epilepticus between 1997 and 2002.
Main Outcome Measures:
Neurodevelopmental outcomes.
Results:
Two of the 25 patients died, resulting in a mortality rate of 8%. No deaths were due to status epilepticus itself. No patient with febrile or idiopathic status epilepticus developed epilepsy. Neurological deterioration was observed in a quarter (six of 23) of the survivors. Symptomatic aetiology (acute or remote) and refractory status epilepticus were associated with adverse outcomes (P<0.05). Young age at status epilepticus (<12 months) and duration of status epilepticus (>60 minutes) tended to be more frequent among those who developed adverse outcome. Rectal diazepam was given before hospital arrival in only four patients.
Conclusions:
Paediatric patients with status epilepticus who had normal neurodevelopmental status before the onset of an attack and who did not sustain an acute insult to the central nervous system or have progressive encephalopathy, had favourable outcomes. Prompt use of rectal diazepam or buccal midazolam administered by caretakers or paramedics should be encouraged.
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