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Refractory status epilepticus in children with and without prior epilepsy or status epilepticus
Iván Sánchez Fernández1, Michele C Jackson1, Nicholas S Abend1
1From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ.
Insights
Children with refractory convulsive status epilepticus (rSE) do not receive faster treatment with a prior epilepsy diagnosis. However, a history of status epilepticus (SE) is linked to quicker initial medication for rSE.
Area of Science:
- Pediatric Neurology
- Epileptology
- Critical Care Medicine
Background:
- Refractory convulsive status epilepticus (rSE) poses significant challenges in pediatric care.
- Understanding factors influencing rSE management and outcomes is crucial for improving patient care.
Purpose of the Study:
- To compare the management and outcomes of rSE in children based on prior epilepsy diagnosis and history of status epilepticus (SE).
Main Methods:
- A prospective observational study included 189 pediatric patients (1 month-21 years) with rSE from June 2011 to May 2016.
- Data collected included prior epilepsy diagnosis, history of SE, and timing of antiepileptic drug (AED) administration.
Main Results:
- While a prior epilepsy diagnosis did not affect the time to first benzodiazepine (BZD), it was associated with a delayed first non-BZD AED and less frequent use of continuous infusions.
- Patients with a history of SE received their first BZD more quickly compared to those without a history of SE.
- Differences in treatment timing were primarily observed in patients with out-of-hospital rSE onset.
Conclusions:
- A prior diagnosis of epilepsy does not appear to expedite rSE treatment in children.
- A history of SE is associated with more prompt administration of initial abortive medications for rSE.
- These findings highlight the importance of considering prior SE history in managing pediatric rSE.
Objective:
To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).
Methods:
This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE.
Results:
We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.2 (1.3-9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [5-60] vs 16.5 [5-42.75] minutes, p = 0.858). Patients with a diagnosis of epilepsy received their first non-benzodiazepine (BZD) antiepileptic drug (AED) later (93 [46-190] vs 50.5 [28-116] minutes, p = 0.002) and were less likely to receive at least one continuous infusion (35/89 [39.3%] vs 57/100 [57%], p = 0.03). Compared to patients with no history of SE, patients with a history of SE received their first BZD earlier (8 [3.5-22.3] vs 20 [5-60] minutes, p = 0.0073), although they had a similar time to first non-BZD AED (76.5 [45.3-124] vs 65 [32.5-156] minutes, p = 0.749). Differences were mostly driven by the patients with an out-of-hospital rSE onset.
Conclusions:
Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication.
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