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Clinical profile and outcome of refractory convulsive status epilepticus in older children from a developing country

Lokesh Lingappa1, Ramesh Konanki1, Ravi Patel1

  • 1Department of Neurology, Rainbow Hospital for Women and Children, Hyderabad, India.

Seizure
|February 19, 2016
PubMed

Insights

Acute symptomatic etiology, often CNS infections, is a common cause of convulsive status epilepticus (CSE) in children. Refractory status epilepticus (RSE) significantly increases the risk of disability and mortality.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Convulsive status epilepticus (CSE) is a neurological emergency with significant morbidity and mortality in children.
  • Refractory status epilepticus (RSE) presents a therapeutic challenge, often requiring advanced management strategies.
  • Understanding the specific etiologies and outcomes of RSE in pediatric populations is crucial for improving patient care.

Purpose of the Study:

  • To investigate the causes, clinical progression, and outcomes of refractory convulsive status epilepticus (RSE) in children aged 2 to 12 years.
  • To identify risk factors associated with the progression from CSE to RSE.
  • To determine the impact of RSE on mortality and long-term disability.

Main Methods:

  • Retrospective analysis of 73 children diagnosed with CSE, aged 2-12 years.
  • Calculation of odds ratios to assess the relationship between variables and clinical course/outcome.
  • Survival analysis to evaluate mortality rates within the study cohort.

Main Results:

  • 45.2% of children with CSE progressed to RSE.
  • Acute symptomatic etiology, particularly CNS infections, was the most frequent cause (60.3%) and a predictor of RSE (OR 2.62).
  • RSE significantly increased the risk of severe sepsis (OR 6.08), acidosis (OR 14.77), mortality (21.2% in RSE vs. 7.5% in non-RSE), and 1-year disability (OR 7.08).

Conclusions:

  • Acute symptomatic etiology is a primary driver of CSE and progression to RSE in older children, especially in developing countries.
  • RSE is strongly linked to adverse outcomes, including increased mortality and significant disability at one year post-discharge.
  • Early identification and management of CSE, particularly in cases with acute symptomatic etiology, are critical to mitigate the risks associated with RSE.
Abstract

Keywords:
Acute symptomaticConvulsive status epilepticusDisabilityMortalityRefractory

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