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Status epilepticus in children: etiology, clinical features, and outcome
1Department of Pediatric-Neurology, Indiana University School of Medicine, Indianapolis 46202.
Insights
Status epilepticus in children, a prolonged seizure lasting over 30 minutes, was often symptomatic and triggered by low anticonvulsant levels or fever. Outcomes depended on cause and duration, with few permanent deficits in idiopathic cases.
Area of Science:
- Pediatric Neurology
- Epileptology
- Critical Care Medicine
Background:
- Status epilepticus is a medical emergency in children.
- Understanding its causes, characteristics, and outcomes is crucial for effective management.
- Prospective data collection is vital for accurate epidemiological studies.
Purpose of the Study:
- To prospectively analyze the characteristics, precipitating factors, and outcomes of convulsive status epilepticus in children.
- To identify risk factors associated with mortality and new neurologic deficits.
- To evaluate the relationship between etiology, duration, and long-term outcomes.
Main Methods:
- Prospective data collection on 114 episodes of convulsive status epilepticus in 97 children between August 1984 and September 1986.
- Defined status epilepticus as seizures lasting longer than 30 minutes.
- Analyzed etiology, precipitating factors, laboratory findings, and patient outcomes, including mortality and neurologic deficits.
Main Results:
- 72% of episodes were symptomatic (chronic or acute), 28% were idiopathic/febrile.
- Common triggers included low anticonvulsant levels and febrile illnesses.
- Mortality occurred in 8 children; 18 developed new neurologic deficits.
- Permanent deficits were rare in idiopathic/febrile cases.
Conclusions:
- The etiology and duration of status epilepticus significantly influence outcomes in children.
- While symptomatic status epilepticus carries higher risks, prompt management can mitigate long-term deficits.
- Age is a less significant factor compared to underlying cause and seizure persistence.
Abstract:
Between August 1984 and September 1986, data were gathered prospectively on 114 episodes of convulsive status epilepticus, defined as seizure duration longer than 30 minutes, affecting 97 children. Status epilepticus was symptomatic in 72% (chronic 59%, acute 13%) and idiopathic or febrile in 28%. We identified precipitating factors in 63% of episodes. The most common factors were inadequate blood levels of anticonvulsants (32 of 60 episodes in children with prior seizures) and febrile illnesses, excluding meningitis or encephalitis (38 of 114 episodes). There was an elevated peripheral white blood cell count in 60%, acidosis with a pH of less than 7.0 in 12.5%, and cerebrospinal fluid pleocytosis not due to meningitis or encephalitis in 8 of 64 episodes. Eight children died, three with severe pre-existing brain damage, two with meningitis, and two with a poorly defined encephalopathy. Eighteen children developed a new neurologic deficit. Outcome was associated with the etiology and duration of status epilepticus, with age at the time of status a minor factor. A permanent deficit occurred in only five children with idiopathic or febrile status epilepticus.