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Epileptic Status in a PEDiatric cohort (ESPED) requiring intensive care treatment: A multicenter, national, two-year
Sascha Meyer1,2, Jaro Langer1, Martin Poryo3
1Department of General Pediatrics and Neonatology, and Neuropediatrics, Saarland University Medical Center, Homburg, Germany.
Insights
This study analyzed pediatric status epilepticus (SE) in the PICU, finding prolonged febrile seizures as a common cause and increased use of new anti-seizure medications (ASMs). Outcomes show a 3.5% mortality rate and new neurological deficits in 6.2% of cases.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Epileptology
Background:
- Status epilepticus (SE) in children is a critical neurological emergency requiring intensive care.
- Understanding the etiology, treatment, and outcomes of pediatric SE is vital for improving patient management.
- International League Against Epilepsy (ILAE) criteria define SE, guiding diagnosis and treatment protocols.
Purpose of the Study:
- To characterize seizure etiology, semiology, and underlying conditions in pediatric patients with SE requiring PICU admission.
- To document in-hospital and out-of-hospital diagnostics and treatments for pediatric SE.
- To report outcomes, including treatment response and neurological deficits, for children experiencing SE.
Main Methods:
- A prospective national surveillance study was conducted over two years (July 2019 - June 2021).
- The study included 481 episodes of SE in children admitted to the pediatric intensive care unit (PICU) for at least 4 hours.
- Data collected included demographics, seizure history, causes, seizure types, treatments administered (pre-clinical, emergency, and clinical), and patient outcomes.
Main Results:
- The most frequent cause of SE was prolonged febrile seizures (20.6%). Generalized seizures were the most common initial type (49.9%).
- Refractory SE occurred in 40.5% of patients, and super-refractory SE in 5.0%.
- New anti-seizure medications (ASMs) were increasingly utilized. Mortality rate was 3.5%, with 6.2% experiencing new neurological deficits.
Conclusions:
- This study offers current, real-world data on pediatric SE requiring PICU admission.
- The findings highlight the growing use of novel ASMs in this vulnerable population.
- This knowledge can inform the development of more standardized treatment approaches for pediatric SE.
Objective:
The aim of this study was to provide seizure etiology, semiology, underlying conditions, and out-of- and in-hospital diagnostics, treatment, and outcome data on children with out-of- or in-hospital-onset status epilepticus (SE) according to the International League Against Epilepsy definition that required admission to the pediatric intensive care unit (PICU) for ≥4 hours.
Methods:
This prospective national surveillance study on SE in childhood and adolescence was conducted over 2 years (07/2019-06/2021).
Results:
This study examined 481 SE episodes in 481 children with a median age of 43 months (1 month to 17 years 11 months), of which 46.2% were female and 50.7% had a previous seizure history. The most frequent acute SE cause was a prolonged, complicated febrile seizure (20.6%). The most common initial seizure types were generalized seizures (49.9%), focal seizures (18.0%), and unknown types (12.1%); 40.5% of patients suffered from refractory SE and 5.0% from super-refractory SE. The three most common medications administered by nonmedically trained individuals were diazepam, midazolam, and antipyretics. The three most frequent anti-seizure medications (ASMs) administered by the emergency physician were midazolam, diazepam, and propofol. The three most common ASMs used in the clinical setting were midazolam, levetiracetam, and phenobarbital. New ASMs administered included lacosamide, brivaracetam, perampanel, stiripentol, and eslicarbazepine. Status epilepticus terminated in 16.0% in the preclinical setting, 19.1% in the emergency department, and 58.0% in the PICU; the outcome was unknown for 6.9%. The median PICU stay length was 2 (1-121) days. The median modified Rankin scale was 1 (0-5) on admission and 2 (0-6) at discharge. New neurological deficits after SE were observed in 6.2%. The mortality rate was 3.5%.
Significance:
This study provides current real-world out-of- and in-hospital data on pediatric SE requiring PICU admission. New ASMs are more frequently used in this population. This knowledge may help generate a more standardized approach.
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