[Status epilepticus in hospitalized children]

Status epilepticus (SE), as it was established in several analyses, occurs in at least 6% of patients with epilepsy. The prognosis, in the high degree, depends on the type and duration of SE, being worse in the case of symptomatic epilepsy, metabolic disease, neuroinfection and hypoxic injury of the brain. Results of therapy are dependent on the proper treatment and rapidity of its initiation as well.

The aim of this research was to establish frequency and type of SE, time of duration and efficacy of treatment of SE in hospitalised children.

1505 children with epilepsy, aged 1 month to 18 years were hospitalised between 1996 and 2004 in the Department of Pediatric Neurology in Cracow. SE was diagnosed in 21 children of all groups, what makes 1.4%. The group consisted of 9 girls and 12 boys. SE appeared most frequently in children diagnosed with epilepsy during the first two years of life (76.2%). In majority of patients (66.66%) SE occurred in the first year, since falling ill with epilepsy (between 1 month and 12 years).

In 6 children SE was shorter than 1 hour, in 11 children shorter than 3 hours and in 4 children longer than 3 hours. 14/21 children became seizure free in the Department of Pediatric Neurology, however in the remaining 7 children continuation of treatment in the Intensive Care Unit was necessary and all children survived. Discontinuation of treatment was not a reason of SE in any of cases. In 18 children with SE (85.7%) symptomatic epilepsy was diagnosed and in another 3 children probable symptomatic. Symptomatic epilepsy was caused by birth trauma in 4 children, in 2 other children was associated with encephalitis, in 6 children with progressive encephalopathy, in the next 3 children with cortical developmental abnormalities and with cerebral palsy in another 3 children. Specific background of epilepsy was not established in 3 children. Drugs were used in the treatment of SE in recommended doses, most frequently Klonazepam (17), Diazepam (8), Gardenal (7), Midazolam (6) and Epanutin (3). In 5 children rectal Chloralhydrat was effective in the therapy of SE. 7/21 children experienced improved seizure control in the Intensive Care Unit due to thiopental coma. Additional antiedematous treatment was provided in 17 children.

The majority of cases of SE in hospitalised patients were related to epilepsy in children during first two years of life and to first year duration of the illness. The low frequency of SE can be related to continuos access to pediatric neurologists and experienced nurse teams.