Early Clinical Variables Associated With Refractory Convulsive Status Epilepticus in Children

Katrina Peariso1, Ravindra Arya2, Tracy Glauser2

  • 1From the Department of Neurology and Physical Medicine and Rehabilitation (K.P.), University of Cincinnati College of Medicine, OH; Division of Pediatric Neurology (R.A., T.G., P.S.H.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Division of Epilepsy and Clinical Neurophysiology (C.B.A., Justice Clark, M.G.-L., K.K., T.L.), Department of Neurology, Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (CBA), Hospital Universitario La Paz, Universidad Autonoma de Madrid, Spain; Pediatric Neurology Unit (M.A.-G.), Department of Pediatrics, Hospital Universitari Son Espases, Universitat de Les Illes Balears, Palma, Spain; Section of Neurology and Developmental Neuroscience (A.A., J.R.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Pediatrics (B.L.A., K.E.C., A.W., K.W.), University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital; Department of Neurology and Pediatrics (J.N.B., H.G.), University of Virginia Health System, Charlottesville; Division of Pediatric Neurology (Jessica Carpenter), University of Maryland School of Medicine, Baltimore; Center for Neuroscience (W.D.G.), Children's National Hospital, George Washington University School of Medicine and Health Sciences, DC; Instituto de Pediatría (M.G.-L.), Facultad de Medicina, Universidad Austral de Chile, Valdivia; Servicio de Neuropsiquiatría Infantil (M.G.-L.), Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.G.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology and Epilepsy (Z.G., B.O.M.), Department of Pediatrics, Weill Cornell Medicine, New York; Division of Pediatric and Developmental Neurology (R.M.G.), Washington University School of Medicine, St. Louis, MO; Department of Pediatrics (L.H.), British Columbia Children's Hospital, the University of British Columbia, Canada; Division of Child and Adolescent Neurology (R.K., A.V.-A.), Department of Neurology, Mayo Clinic, Rochester, MN; Division of Pediatric Neurology (S.A.K., E.H.K., C.E.S.), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; Section of Pediatric Critical Care Medicine (Y.-C.L.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Pediatrics (T.M.), Division of Neurology and Epilepsy, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL; Division of Pediatric Neurology (M.A.M., D.T.), Duke University Medical Center, Duke University, Durham, NC; Department of Neurology (L.M., E.N., M.S.W.), Division of Child Neurology, Seattle Children's Hospital, WA; Department of Pediatrics (A.P.O.), Nationwide Children's Hospital, The Ohio State University, Columbus; Division of Neurology (E.T.P.), Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada; Division of Neurology (J.P.), Doernbecher Children's Hospital, Oregon Health & Science University, Portland; Division of Child Neurology & Institute for Genomic Medicine (T.S.), Columbia University Irving Medical Center, New York Presbyterian Hospital; and Department of Anesthesiology (R.C.T.), Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, MA. peariska@ucmail.uc.edu.

Neurology
|June 9, 2023
PubMed

Insights

A family history of seizures or rectal diazepam prescription may decrease the risk of refractory convulsive status epilepticus (RSE) in children. These factors, identified early, can help tailor pediatric emergency care for better outcomes.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Clinical Research

Background:

  • Refractory convulsive status epilepticus (RSE) poses a significant challenge in pediatric emergency care.
  • Identifying predictive factors for RSE is crucial for timely and effective intervention.

Purpose of the Study:

  • To determine patient-specific factors present early in emergency care that are associated with the development of RSE in children.
  • To compare clinical variables between children with responsive established status epilepticus (rESE) and RSE.

Main Methods:

  • An observational case-control study compared pediatric patients (1 month-21 years) with rESE and RSE.
  • Clinical variables acquired early after presentation were analyzed using univariate and multivariable logistic regression.
  • Data were sourced from the pediatric Status Epilepticus Research Group study cohort.

Main Results:

  • No significant difference in time to first benzodiazepine (BZD) between RSE and rESE groups.
  • Time to second-line antiseizure medication (ASM) was shorter in the RSE group (p=0.021).
  • A family history of seizures (OR 0.37) and rectal diazepam prescription (OR 0.21) were associated with decreased odds of RSE.

Conclusions:

  • Early clinical factors, specifically family history of seizures and rectal diazepam prescription, are associated with a decreased likelihood of RSE progression.
  • These findings suggest that early identification of these factors can aid in patient-tailored care for pediatric convulsive seizures.
  • Class II evidence indicates that patient and clinical factors can predict RSE in children.
Abstract

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