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Aborted and refractory status epilepticus in children: a comparative analysis
Florise A C P Lambrechtsen1, Jeffrey R Buchhalter
1University Medical Center Groningen, Groningen, The Netherlands.
Insights
Refractory status epilepticus (RSE) in children is linked to higher mortality and worse long-term outcomes compared to medically aborted status epilepticus (ASE). Predictors of poor outcome include prolonged seizures, acute etiology, nonconvulsive SE, and young age.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Status epilepticus (SE) is a neurological emergency in children.
- Differentiating between medically aborted SE (ASE) and refractory SE (RSE) is crucial for prognosis.
- Understanding predictors of long-term outcomes in pediatric SE is essential for management.
Purpose of the Study:
- To compare demographics, clinical features, etiology, and EEG findings between ASE and RSE in children.
- To describe treatment responses in pediatric SE.
- To identify predictors of long-term outcomes in children experiencing SE.
Main Methods:
- Retrospective review of medical records and EEG logs for children (under 18) with SE.
- Inclusion criteria: hospitalization between 1994-2004 at Mayo Clinic, Rochester.
- Analysis of patient data including demographics, clinical characteristics, etiology, EEG findings, treatment, and outcomes.
Main Results:
- 154 children had SE; 61% ASE, 39% RSE.
- RSE associated with family history of seizures, higher seizure frequency, more AEDs, nonconvulsive SE, and focal/electrographic seizures on EEG.
- In-hospital mortality higher in RSE (13.3%) vs. ASE (2.1%). RSE survivors had more neurological deficits and epilepsy.
- Poor outcome predictors: prolonged seizure duration, acute symptomatic etiology, nonconvulsive SE, and age < 5 years.
Conclusions:
- Specific patient and clinical factors predict RSE development and poor outcomes in children.
- Aggressive treatment approaches may improve treatment response and outcomes.
- Further prospective, randomized trials are needed to optimize SE treatment protocols in children.
Purpose:
The aims of this retrospective study were: (1) to compare the demographics, clinical characteristics, etiology, and EEG findings of status epilepticus aborted with medication (ASE) and refractory status epilepticus (RSE), (2) to describe the treatment response of status epilepticus (SE), and (3) to determine predictors of long-term outcome in children with SE.
Methods:
Medical records and EEG lab logs with ICD-9 diagnostic codes related to SE were reviewed. Patients younger than 18 years of age, hospitalized in 1994-2004 at the Mayo Clinic, Rochester, were included.
Results:
One hundred fifty-four children had SE; 94 (61%) had ASE, and 60 (39.0%) had RSE. Family history of seizures, higher seizure frequency score, higher number of maintenance antiepileptic drugs (AEDs), nonconvulsive SE, and focal or electrographic seizures on initial EEG were associated with RSE by univariate analysis. In-hospital mortality was significantly higher in RSE (13.3%) than in ASE (2.1%). In the long term, survivors with RSE developed more new neurological deficits (p < 0.001) and more epilepsy (p < 0.004) than children with ASE. Children treated in a more aggressive fashion appeared to have better treatment responses (p < 0.001) and outcomes (p = 0.03). Predictors of poor outcome were long seizure duration (p < 0.001), acute symptomatic etiology (p = 0.04), nonconvulsive SE (NCSE) (p = 0.01), and age at admission <5 years (p = 0.05).
Discussion:
Several patient and clinical characteristics are associated with development of RSE and poor outcome. Prospective, randomized trials that assess different treatment protocols in children with SE are needed to determine the optimal sequence and timing of medications.
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