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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.

|December 21, 2007

Summary

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.

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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.