Comparison of pediatric patients with status epilepticus lasting 5-29 min versus ≥30 min
Iván Sánchez Fernández1, Martina Vendrame2, Kush Kapur3
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain.
Insights
The 5-minute and 30-minute thresholds for pediatric status epilepticus (SE) identify similar patient groups. This finding suggests current definitions may not significantly differentiate electroclinical characteristics in children experiencing prolonged seizures.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Status epilepticus (SE) is defined by seizure duration, with common thresholds at 5 or 30 minutes.
- The clinical implications of these different thresholds in pediatric populations remain unclear.
- Understanding patient characteristics associated with each threshold is crucial for accurate diagnosis and management.
Purpose of the Study:
- To compare the electroclinical characteristics of pediatric patients with SE lasting 5-29 minutes (SE5-29) versus those with SE lasting ≥30 minutes (SE≥30).
- To determine if different SE duration thresholds identify distinct patient subgroups.
- To inform potential revisions of pediatric SE diagnostic criteria.
Main Methods:
- Retrospective analysis of 445 pediatric patients (1 month to 21 years) with convulsive seizures lasting ≥5 minutes.
- Patients were categorized into SE5-29 (n=296) and SE≥30 (n=149) groups.
- Comparison of demographic, clinical, neuroimaging, and electrophysiological data between the two groups.
Main Results:
- Patients in the SE≥30 group were younger at seizure onset (median 1 vs. 2.1 years) and more likely to present with SE as their first seizure manifestation (24.2% vs. 12.2%).
- A trend towards higher rates of baseline magnetic resonance imaging (MRI) abnormalities was observed in the SE≥30 group (70.5% vs. 57.1%).
- No significant differences were found in seizure frequency, seizure types, developmental delay, or baseline EEG abnormalities.
Conclusions:
- In pediatric populations, both 5-minute and 30-minute thresholds for SE capture patient groups with largely similar electroclinical profiles.
- Age at onset and SE as a first presentation are distinguishing factors, with younger children and those with new-onset SE more likely to meet the ≥30 minute criteria.
- These findings suggest that current SE duration thresholds may not adequately differentiate pediatric patient populations and could influence future diagnostic definitions.
Abstract:
The most common thresholds for considering prolonged seizures as status epilepticus (SE) are 5 and 30 min. It is unknown whether these different thresholds (5 or 30 min) identify patient populations with different electroclinical characteristics. We compared the characteristics of patients with SE lasting 5-29 min (SE5-29) with those with SE lasting ≥30 min (SE≥30). Inclusion criteria were the following: 1) 1 month to 21 years of age at the time of SE, 2) convulsive seizures, and 3) seizure duration ≥5 min. Exclusion criteria were the following: 1) exclusively neonatal seizures, 2) psychogenic nonepileptic seizures, or 3) incomplete information about seizure duration. Four hundred forty-five patients (50.1% male) with a median (p25-p75) age at SE of 5.5 (2.8-10.5) years were enrolled. Status epilepticus lasted for 5-29 min in 296 (66.5%) of subjects and for ≥30 min in 149 (33.5%). Patients with SE≥30 were younger than the patients with SE5-29 at the time of seizure onset (median: 1 versus 2.1 years, p=0.0007). Status epilepticus as the first seizure presentation was more frequent in patients with SE≥30 (24.2% versus 12.2%, p=0.002). There was a tendency towards a higher rate of abnormalities in the magnetic resonance imaging at baseline in patients with SE≥30 (70.5% versus 57.1%, p=0.061). Differences were not detected in seizure frequency, seizure types, presence of developmental delay, and electroencephalogram abnormalities at baseline. In the pediatric population, SE thresholds of either 5 or 30 min identify groups of patients with very similar electroclinical characteristics, which may influence future definitions of pediatric SE.
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