[Markers of poor prognosis in convulsive status epilepticus]
R Reig Sáenz1, A Sánchez Miralles, M Herrera Murillo
1Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario de Alicante, Spain. reig_rob@gva.es
Insights
Childhood convulsive status epilepticus has high mortality and morbidity. Refractory seizures and symptomatic epilepsy indicate poor outcomes, while absence of symptomatic epilepsy predicts a favorable prognosis.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
Context:
- Convulsive status epilepticus (CSE) in children is a critical neurological emergency.
- Understanding factors influencing outcomes in pediatric CSE is crucial for effective management.
Purpose:
- To identify variables associated with mortality and neurological deficits in children experiencing CSE.
- To analyze epidemiologic and clinical factors related to neurological outcomes in pediatric intensive care unit (PICU) patients.
Summary:
- This study reviewed 41 children (1 month to 15 years) with CSE admitted to a PICU.
- Mortality was 14.6%, with 22% experiencing adverse neurological outcomes.
- Refractory CSE and symptomatic epilepsy were significantly linked to poor outcomes.
Impact:
- Symptomatic origin and refractory CSE are key indicators of poor prognosis in pediatric CSE.
- Children without symptomatic epilepsy demonstrate a favorable outcome.
- Findings highlight the need for targeted interventions for high-risk pediatric CSE patients.
Objective:
To characterize the variables that might be associated with mortality and the development of neurological deficits in children with convulsive status epilepticus.
Patients And Methods:
Children older than 1 month and younger than 15 years who were admitted to the pediatric intensive care unit of a university hospital between 2001 and 2004 were reviewed. Epidemiologic and clinical factors that might be related to neurological outcome at discharge from the unit were analyzed.
Results:
Forty-one patients (median age 24 months) were included. A total of 48.3% developed refractory convulsive status epilepticus. Six patients died (mortality 14.6%) during their intensive care unit stay and neurologic worsening was observed in 8.6% of survivors (adverse outcome in 22%). Symptomatic epilepsy was present in all patients who died and in 88.9% of those who recovered with severe neurologic sequelae. Uni- and multivariate analysis showed that adverse outcome was related to symptomatic origin and refractory convulsive status epilepticus (p < 0.05).
Conclusions:
Mortality and morbidity is high in childhood convulsive status epilepticus. Refractory convulsive status and symptomatic origin were markers of poor outcome. Children who did not have symptomatic epilepsy had a favorable outcome.
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