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Factors associated with long-term outcomes in pediatric refractory status epilepticus
Marina Gaínza-Lein1,2,3, Cristina Barcia Aguilar1,4, Juan Piantino5
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Pediatric refractory status epilepticus (RSE) can lead to new neurological deficits, particularly with longer seizure duration. Many children develop recurrent seizures post-RSE, highlighting the need for ongoing monitoring and management.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Outcomes Research
Background:
- Refractory status epilepticus (RSE) in children presents significant long-term challenges.
- Understanding the sequelae of pediatric RSE is crucial for effective patient management.
Purpose of the Study:
- To describe long-term clinical and developmental outcomes in pediatric RSE.
- To identify factors predicting new neurological deficits post-RSE.
Main Methods:
- Retrospective analysis of prospectively collected data from pediatric RSE patients (June 2011-March 2020).
- Evaluation of clinical and developmental outcomes at least 30 days post-RSE.
- Risk factor analysis for new neurological deficits in previously normally developed patients.
Main Results:
- Follow-up in 276 patients revealed a 4% in-hospital mortality and 5.4% post-discharge mortality.
- 62.9% experienced subsequent unprovoked seizures; 16.9% had recurrent RSE.
- Among previously normally developing patients, 39.3% had new neurological deficits (cognitive, behavioral, motor).
- Longer electroclinical RSE duration predicted new deficits (p=0.027).
- 24.4% had unfavorable functional outcomes, associated with continuous infusion use.
Conclusions:
- Pediatric RSE is associated with significant long-term morbidity, including recurrent seizures and new neurological deficits.
- Extended electroclinical RSE duration is a key predictor of adverse developmental outcomes.
- Continuous infusion use may be linked to poorer functional outcomes.
Objective:
This study was undertaken to describe long-term clinical and developmental outcomes in pediatric refractory status epilepticus (RSE) and identify factors associated with new neurological deficits after RSE.
Methods:
We performed retrospective analyses of prospectively collected observational data from June 2011 to March 2020 on pediatric patients with RSE. We analyzed clinical outcomes from at least 30 days after RSE and, in a subanalysis, we assessed developmental outcomes and evaluated risk factors in previously normally developed patients.
Results:
Follow-up data on outcomes were available in 276 patients (56.5% males). The median (interquartile range [IQR]) follow-up duration was 1.6 (.9-2.7) years. The in-hospital mortality rate was 4% (16/403 patients), and 15 (5.4%) patients had died after hospital discharge. One hundred sixty-six (62.9%) patients had subsequent unprovoked seizures, and 44 (16.9%) patients had a repeated RSE episode. Among 116 patients with normal development before RSE, 42 of 107 (39.3%) patients with available data had new neurological deficits (cognitive, behavioral, or motor). Patients with new deficits had longer median (IQR) electroclinical RSE duration than patients without new deficits (10.3 [2.1-134.5] h vs. 4 [1.6-16] h, p = .011, adjusted odds ratio = 1.003, 95% confidence interval = 1.0008-1.0069, p = .027). The proportion of patients with an unfavorable functional outcome (Glasgow Outcome Scale-Extended score ≥ 4) was 22 of 90 (24.4%), and they were more likely to have received a continuous infusion.
Significance:
About one third of patients without prior epilepsy developed recurrent unprovoked seizures after the RSE episode. In previously normally developing patients, 39% presented with new deficits during follow-up, with longer electroclinical RSE duration as a predictor.
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