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Refractory Convulsive Status Epilepticus in Children: Etiology, Associated Risk Factors and Outcome
Mohammad Barzegar1, Mohammad Mahdavi2, Afshin Galegolab Behbehani3
1Pediatric Neurology Department Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Insights
Refractory status epilepticus (RSE) in children is often caused by acute symptomatic etiology, such as encephalitis. Early management of these conditions is crucial to prevent mortality and long-term neurological deficits.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Epidemiology
Background:
- Refractory status epilepticus (RSE) presents a significant threat to children, characterized by seizures unresponsive to initial anticonvulsant therapy.
- RSE is associated with substantial rates of mortality and long-term morbidity in pediatric populations.
Purpose of the Study:
- To identify risk factors contributing to the progression from status epilepticus (SE) to RSE in children.
- To evaluate the early outcomes for pediatric patients diagnosed with RSE.
Main Methods:
- A retrospective study of pediatric patients with SE hospitalized at Tabriz Children's Hospital between 2007 and 2008.
- Data collected included clinical profiles, etiology, treatment modalities, and patient outcomes upon discharge.
Main Results:
- Out of 132 SE patients, 53 (40.15%) had RSE. Acute symptomatic etiology was a significant risk factor for developing RSE (P=0.004), with encephalitis being the most common cause.
- No significant association was found between RSE and patient age, gender, initial drug intake timing, or seizure type.
- The mortality rate was 8.3%, and new neurological deficits occurred in 25.7% of cases. Patients with RSE, particularly those with encephalitis, had poorer outcomes compared to non-RSE patients (P=0.006).
Conclusions:
- The etiology of SE critically impacts prognosis, with a higher incidence of RSE observed in the acute symptomatic group.
- Prompt and effective management of acute neurological insults like encephalitis and meningitis is essential to mitigate the risk of permanent brain damage in children with SE.
Objective:
Refractory status epilepticus (RSE) is a life-threatening disease in children wherein the patient's convulsive seizures do not respond to adequate initial anticonvulsants. RSE is associated with high rate of mortality and morbidity. This study was aimed to survey the risk factors leading status epilepticus (SE) to RSE in children, and their early outcome.
Materials & Methods:
Patients with SE hospitalized in Tabriz Children's Hospital, Iran were studied during the years 2007 and 2008 with regard to their clinical profile, etiology, the treatment methods available to them and their outcome upon release from the hospital.
Results:
Among 132 patients with SE, 53 patients (40.15%) suffered from RSE. Acute symptomatic etiology was a risk factor responsible for developing RSE in the patient (P=0.004). Encephalitis was the most common etiology of acute symptomatic SE. There was no significant relationship observed between RSE and the patients' age, gender, date of initial drug intake and type of seizure. The mortality rate was 8.3% and a new neurological deficit occurred in 25.7% of cases. None of RSE with encephalitis returned to the baseline status. Mortality and morbidity rates were significantly higher in children with RSE than in those with SE (P=0.006).
Conclusion:
Etiology of SE significantly influenced prognosis of it with significant incidence of RSE in acute symptomatic group. Because acute neurological insult such as encephalitis and meningitis are common causes of RSE in children, properly management of them is necessary to avoid permanent brain damage.
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