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Severe refractory status epilepticus owing to presumed encephalitis
Uri Kramer1, Zamir Shorer, Bruria Ben-Zeev
1Child Development Center and Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Israel. umkramer@netvision.net.il
Journal of Child Neurology
|April 19, 2005
Summary
Severe refractory status epilepticus in children, often presumed due to encephalitis, is rare. Even with induced coma, seizures persisted, leading to high mortality and significant cognitive issues in survivors.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Infectious Diseases
Background:
- Severe refractory status epilepticus (SRSE) is a rare but devastating neurological emergency in children.
- Presumed encephalitis is an uncommon but serious cause of SRSE.
- Limited data exists on the outcomes of pediatric SRSE secondary to encephalitis.
Purpose of the Study:
- To describe the clinical characteristics, management, and outcomes of eight children with SRSE presumed to be caused by encephalitis.
- To highlight the challenges in managing this rare condition in pediatric patients.
Main Methods:
- Case series describing eight pediatric patients with SRSE.
- Detailed clinical and laboratory investigations were performed.
- Management involved induced burst suppression coma using various anesthetic agents (pentothal, midazolam, propofol, ketamine).
- Duration of anesthesia and seizure control were monitored.
Main Results:
- Patients ranged from 2.5 to 15 years old; seven had preceding fever.
- Despite prolonged induced coma (mean 28 days), seizures persisted in all patients.
- Two children died, and four survivors experienced ongoing seizures and cognitive deficits.
- Etiology remained undetermined in all cases despite extensive workup.
Conclusions:
- SRSE in children, even when presumed due to mild encephalitis, carries a high mortality rate.
- Management with induced coma is often ineffective in controlling persistent seizures.
- Significant morbidity, including refractory seizures and cognitive sequelae, is common in survivors.
- Further research is needed to identify effective treatments for this rare condition.