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Low morbidity and mortality of status epilepticus in children
J Maytal1, S Shinnar, S L Moshé
1Montefiore Epilepsy Center, Albert Einstein College of Medicine, Bronx, New York.
Insights
Status epilepticus in children has a low mortality and sequelae rate, primarily dependent on the cause. Acute or progressive neurologic insults significantly increase risks, while younger age correlates with worse outcomes due to underlying conditions.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Status epilepticus (SE) is a medical emergency in children.
- Understanding the outcomes of SE is crucial for prognosis and management.
Purpose of the Study:
- To investigate the mortality and sequelae of pediatric status epilepticus.
- To identify factors influencing outcomes, including etiology and age.
Main Methods:
- Prospective and retrospective follow-up of 193 children with SE.
- Classification of SE causes: idiopathic, remote symptomatic, febrile, acute symptomatic, progressive neurologic.
- Analysis of mortality, new neurologic deficits, and subsequent unprovoked seizures.
Main Results:
- Low overall mortality (7/193) and sequelae (17/186 survivors).
- Higher risk of death and sequelae in children with acute/progressive neurologic insults (P < .001).
- Younger age (<1 year) associated with higher sequelae, reflecting underlying acute neurologic disease.
Conclusions:
- Etiology is the primary determinant of outcome in pediatric SE.
- Proactive management is essential for children with acute neurologic insults.
- Age-related outcomes are mainly due to the prevalence of specific etiologies in different age groups.
Abstract:
In an ongoing study of status epilepticus, 193 children with status epilepticus of varying causes have been followed up for a mean period of 13.2 months. Of these, 97 patients were recruited prospectively. The patients' ages ranged from 1 month to 18 years (mean, 5.0 years). The cause of the status epilepticus was classified as idiopathic in 46 cases, remote symptomatic in 45, febrile in 46, acute symptomatic in 45, and progressive neurologic in 11. The mortality and incidence of sequelae following status epilepticus was low and primarily a function of etiology. Seven children died within 3 months of having the seizure. New neurologic deficits were found in 17 (9.1%) of the 186 survivors. All of the deaths and 15 of the 17 sequelae occurred in the 56 children with acute or progressive neurologic insults. Only two of the 137 children with other causes sustained any new deficits (P less than .001). Duration of the status epilepticus affected outcome only within the acute symptomatic group (P less than .05). Neurologic sequelae occurred in 29% of infants younger than 1 year of age, 11% of children 1 to 3 years of age, and 6% of children older than 3 years of age. However, this was a reflection of the greater incidence of acute neurologic disease in the younger age groups. Within each cause, age did not affect outcome. Of the 193 children, 61 (32%) had a history of prior unprovoked seizures. Of the 125 surviving children with no history of prior unprovoked seizures, 37 (30%) had subsequent unprovoked seizures.(ABSTRACT TRUNCATED AT 250 WORDS)