Related Experiment Video
Updated: Apr 10, 2026
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Admissions to paediatric intensive care units (PICU) with refractory convulsive status epilepticus (RCSE): A two-year
I Tully1, E S Draper2, C R Lamming2
1Alder Hey Children's Hospital, Eaton Road, Liverpool, Merseyside L12 2AP, United Kingdom; Institute of Medical Genetics, University Hospital of Wales, Heath Park, Cardiff CF14, United Kingdom.
Insights
Refractory convulsive status epilepticus (RCSE) in children is often treated with thiopentone. This study found low mortality rates and few new neurological deficits at 30-day follow-up for pediatric intensive care unit patients.
Area of Science:
- Pediatric intensive care
- Neurology
- Epidemiology
Background:
- Refractory convulsive status epilepticus (RCSE) is a neurological emergency in children.
- Understanding its epidemiology, management, and outcomes is crucial for improving patient care.
- Limited national data exists on RCSE in pediatric intensive care units (PICUs).
Purpose of the Study:
- To gather national epidemiological data on the causes, treatments, and outcomes of RCSE in children.
- To analyze management strategies and adherence to protocols in PICUs.
- To assess the short-term neurological outcomes and incidence of de novo epilepsy following RCSE.
Main Methods:
- Retrospective data collection from eight PICUs in the UK between 2008 and 2009.
- Standardized proforma used for data collection, coordinated by PICANet.
- Analysis of data from 151 pediatric patients diagnosed with RCSE.
Main Results:
- The most common causes included febrile seizures (18.2%), remote symptomatic (29.0%), and acute symptomatic (15.2%) etiologies.
- Thiopentone was the most frequently used third-line treatment (65.6%).
- Mortality was 4.0%, with 11.3% developing new neurological deficits and 7.9% developing de novo epilepsy.
Conclusions:
- Thiopentone is a primary anticonvulsant for RCSE in PICUs.
- The study highlights a low mortality rate and a manageable incidence of new neurological deficits.
- Adherence to the APLS protocol varied, indicating areas for potential improvement in management.
Aims:
To obtain national epidemiological data on the aetiology, management and outcome of refractory convulsive status epilepticus (RCSE) in children.
Methods:
Data on children admitted with RCSE between 01.01.2008 and 31.12.2009, to eight paediatric intensive care units (PICUs) were retrospectively collected using a standard proforma designed with and co-ordinated by PICANet.
Results:
Data were collected on 245 (male, 179) patients aged between <1 month and 16.5 years (median 2.8 years, IQR 1-7.43 years), of which: One hundred and fifty-one patients (male, 89) aged between <1 month and 16.5 years (median 2.3 years, IQR 1-7.17 years) met the study criteria for a diagnosis of RCSE. Causes included acute symptomatic (15.2%), remote symptomatic (29.0%), epilepsy-related (10.6%), progressive encephalopathy (10.6%) febrile seizures (18.2%); no cause was identified in 16.4%. First line treatments included lorazepam (118 patients, 78.1%), diazepam (72, 47.7%) and midazolam (37, 24.5%). Second-line treatments included phenytoin (125 patients, 82.8%) and phenobarbital (seven patients, 4.6%). Third-line treatments included a thiopentone bolus (99 patients, 65.6%), thiopentone infusion (20, 13.2%) midazolam infusion (56, 37.1%) phenobarbital (18, 11.9%), propofol (6, 4.0%) and clonazepam (2, 1.3%). Deviation from the national advanced paediatric life support (APLS) protocol was noted in approximately one quarter of all patients. Six patients died (4.0%). Seventeen patients (11.3%) developed a new neurological deficit on discharge from PICU, of which eight (5.3%) continued to show this deficit at a 30-day follow-up and 12 patients (7.9%) developed de novo epilepsy.
Conclusions:
Thiopentone was the most commonly used anticonvulsant to treat RCSE on admission to PICU. Mortality was low and approximately 1 in 25 showed a new neurological deficit at the 30-day follow-up.
More Related Videos
10:22Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
Published on: December 6, 2016
08:43Long-term Continuous EEG Monitoring in Small Rodent Models of Human Disease Using the Epoch Wireless Transmitter System
Published on: July 21, 2015
Related Concept Videos
01:13Seizures: Classification
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
01:24Epilepsy and Seizures: Overview
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
01:18Antiepileptic Drugs: GABAergic Pathway Potentiators
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for...
01:30Electroconvulsive Therapy
01:20Antiepileptic Drugs: Potassium Channel Activators
Ezogabine has gained approval as an adjunctive treatment...
01:14Antiepileptic Drugs: Glutamate Antagonists