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Etiology and mortality of status epilepticus in children. A recent update
1Department of Pediatric Neurology, Children's Hospital, Oakland, CA 94609.
Insights
Status epilepticus (SE) in children is often the first seizure, particularly in younger children. Acute causes are more frequent in infants, while known epilepsy is more common in older children, with decreasing mortality rates observed.
Area of Science:
- Pediatric Neurology
- Epileptology
- Critical Care Medicine
Background:
- Status epilepticus (SE) is a neurological emergency in children.
- Understanding the etiology and outcomes of SE is crucial for pediatric care.
Purpose of the Study:
- To analyze the causes and outcomes of pediatric status epilepticus.
- To investigate age-related differences in SE etiology.
- To compare current mortality rates with historical data.
Main Methods:
- Retrospective review of medical records for 218 SE episodes in 193 children.
- Data collected between 1983 and 1987.
- Analysis of patient demographics, seizure characteristics, etiology, and outcomes.
Main Results:
- SE occurred in 61% of boys and 39% of girls, aged 1 month to 14 years (average 3.2 years).
- 73% of episodes were in children under 5 years; 71% of SE episodes were the initial seizure.
- Acute causes predominated in infants (<1 year), while known epilepsy was more common in older children (>3 years). Overall mortality was 6%.
Conclusions:
- The etiology of pediatric status epilepticus is significantly age-dependent.
- Acute causes are more prevalent in younger children presenting with SE.
- Mortality associated with pediatric SE appears to have decreased over time.
Abstract:
We reviewed the medical records of 218 episodes of status epilepticus in 193 children who were admitted to the hospital between 1983 and 1987. Of the episodes, 61% were in boys and 39% in girls, with an age range of 1 month to 14 years (average, 3.2 years). The majority of episodes (73%) occurred in patients who were less than 5 years old, with 61% less than 3 years old and 28% less than 1 year old. Status epilepticus as the initial seizure occurred in 71% of episodes. In patients under 1 year of age, 75% of episodes were associated with acute causes (bacterial meningitis in 28% and electrolyte disorders in 30%), and 23% were idiopathic (19% associated with fever). In children less than 3 years old, 47% of episodes had an acute cause, 9% had a previously known seizure disorder, and 32% were idiopathic (30% associated with fever). In patients older than 3 years, 28% of episodes were associated with acute causes, 38% were known epileptics, and 13% were idiopathic (11% had fever). Overall mortality was 6%, with 1% of all episodes ending in death during the presenting seizure. We conclude that the etiology of status epilepticus is age related, with acute causes being more common in patients with a younger age at presentation. When our data are compared with other large studies in children, it appears that mortality associated with status epilepticus has decreased.