Pediatric status epilepticus: Identification of prognostic factors using the new ILAE classification after 5 years of follow-up
Nicola Specchio1, Nicola Pietrafusa1, Marcello Bellusci2
1Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù' Children's Hospital, IRCCS, Rome, Italy.
Insights
Status epilepticus (SE) in children is a common emergency. Longer duration and earlier onset of SE increase the risk of poor neurocognitive outcomes, while acute symptomatic causes reduce epilepsy development risk.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neuroscience
Background:
- Status epilepticus (SE) represents a significant neurological emergency in pediatric populations.
- Accurate classification and identification of prognostic factors are crucial for managing SE outcomes.
Purpose of the Study:
- To analyze a large cohort of pediatric patients with SE.
- To apply the International League Against Epilepsy (ILAE) Classification for SE.
- To identify prognostic factors influencing neurocognitive outcome, SE recurrence, epilepsy development, and mortality.
Main Methods:
- Retrospective analysis of 173 pediatric patients treated for SE exceeding 30 minutes.
- Application of the ILAE Classification for SE.
- Multivariate logistic regression to determine adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for various outcomes.
Main Results:
- Superrefractory SE correlated with increased risk of cognitive (OR 6.00) and neurologic sequelae (OR 4.9). Neonatal onset SE also increased risks for cognitive (OR 4.84) and neurologic sequelae (OR 9.03).
- SE recurrence was associated with unknown etiology (OR 6.15) and myoclonic semiology (OR 6.1).
- Acute symptomatic etiology (OR 0.12) was linked to a lower risk of developing epilepsy, which occurred in 69.9% of patients.
Conclusions:
- Age at onset and SE duration are key predictors of worse neurocognitive outcomes.
- The risk of developing epilepsy is reduced following acute symptomatic and febrile SE.
- The ILAE classification, with its four axes, offers an appropriate framework for understanding SE etiology and prognosis.
Objective:
Status epilepticus (SE) is the most common neurologic emergency in childhood. This study aimed to report on a large cohort of pediatric patients with SE, applying the International League Against Epilepsy (ILAE) Classification for SE to identify prognostic factors.
Methods:
We included 173 children treated at "Bambino Gesù" Children's Hospital in Rome for SE exceeding 30 minutes (mean age 4.43 ± 4.93 years old, median 2.28, interquartile range [IQR] 0.41-7.32; follow-up for a mean of 4.9 ± 3.4 years, median 8.75, IQR 4,58-12.63). A multivariate model was constructed to predict neurocognitive outcome, recurrence of SE, development of epilepsy, and mortality. Adjusted odds ratios [ORs] were calculated with 95% confidence interval (OR, 95% CIs).
Results:
We observed a different prevalence of etiologies for the different semiologies (P < .05) and for each age group (P < .05), overlapping only in part with the recent ILAE classification. After SE, patients showed 69.9% epilepsy (drug-resistant in half of them), 23.1% worsening of neurologic findings on examination, 28.9% cognitive deficit, and 28.3% recurrent SE. At multivariate analysis: superrefractory SE was correlated to an increased risk of developing cognitive (OR 6.00, 95% CI 2.09, 17.31) or neurologic sequelae (OR 4.9, 95% CI 1.75, 19.77). A similar finding was observed for patients with onset in the neonatal period for cognitive (OR 4.84, 95% CI 1.13, 17.3) and neurologic sequelae (OR 9.03, 95% CI 2.40, 34.04). Recurrence of SE was associated with unknown etiology (OR 6.15, 95% CI 1.43, 26.76), and myoclonic semiology (OR 6.1, 95% CI 1.23, 29.3). Patients with acute symptomatic etiology (OR 0.12, 95% CI 0.04, 0.40) had a lower risk for developing epilepsy.
Significance:
Age at onset and duration of SE were critical independent variables associated with worse neurocognitive outcome. The risk of developing epilepsy was lower after acute symptomatic and febrile SE. Semiology and age at onset correlate with etiology of SE. For this reason, ILAE classification with respect to four axes seems an appropriate advancement.
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