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The Prognostic Factors in Children With Status Epilepticus and Status Epilepticus Severity Score Scales
Serap Bilge1, Gülen Gül Mert1, Özlem Hergüner1
1Department of Pediatric Neurology, College of Medicine, Balcalı Hospital, Çukurova University, Adana, Turkey.
Insights
The modified status epilepticus severity score (mSTESS) effectively predicts outcomes in pediatric status epilepticus (SE). Factors like nonconvulsive SE and comorbidities indicate a poor prognosis, highlighting the score's clinical utility.
Area of Science:
- Pediatric Neurology
- Epileptology
- Critical Care Medicine
Background:
- Status epilepticus (SE) is defined by the ILAE as seizures lasting over 5 minutes or multiple seizures without regaining consciousness.
- Evaluating prognostic factors and the modified status epilepticus severity score (mSTESS) is crucial for managing pediatric SE.
- International comparison of mSTESS reliability aids in standardizing SE prognosis assessment.
Purpose of the Study:
- To assess prognostic factors in pediatric status epilepticus (SE).
- To evaluate the reliability of the modified status epilepticus severity score (mSTESS) in predicting SE outcomes.
- To compare local SE patient data with international mSTESS-treated cohorts.
Main Methods:
- Retrospective analysis of 72 pediatric patients (1 month-17 years) with SE treated at a university hospital ICU.
- Data collection included patient demographics, epilepsy history, SE etiology, comorbidities, and treatment details.
- Prognostic factors and outcomes were analyzed, correlating with the mSTESS.
Main Results:
- The mean age of SE patients was 5 years, with 61% having comorbidities.
- Common etiologies included meningoencephalitis (19%) and febrile status (8%).
- Unfavorable prognosis was linked to nonconvulsive SE, abnormal EEG/MRI-CT, coma, and comorbidities; mortality was 1%.
Conclusions:
- The modified status epilepticus severity score (mSTESS) is a practical tool for predicting pediatric SE prognosis.
- Nonconvulsive SE, abnormal neurological findings (EEG, MRI-CT), altered consciousness, and comorbidities predict poor outcomes.
- The mSTESS demonstrates reliability in assessing SE severity and guiding clinical management in children.
Abstract:
Background: According to the International League Against Epilepsy (ILAE) 2015 classification, status epilepticus (SE) is a seizure that lasts longer than 5 min or a frequency of more than one seizure within 5 min, without returning to a normal level of consciousness between episodes. In this study, we aimed to evaluate the prognostic factors of SE and compare our patients with those of patients treated internationally with the modified status epilepticus severity score (mSTESS) to determine the reliability of this scoring system. Methods: The medical records of patients aged 1 month-17 years with SE who were treated at Çukurova University-Balcalı Training and Research Hospital between September 2018 and September 2021 and who were followed in the intensive care unit were included in the study. Results: Seventy-two patients were included in this study. The mean age of the patients with SE was 5 years (3-8). The male/female ratio was 34 (47%)/38 (53%). A history of epilepsy was present in 53% of the patients. The most common etiologies behind SE were meningoencephalitis (19%), febrile status (8%), unknown status (12%), and genetic causes (7%). Comorbidities, including developmental delay/intellectual disability, cerebral palsy, hyperactivity, and autism spectrum disorder, were present in 44 (61%) of the patients. The cutoff was ≥ 2 for unfavorable outcomes and 4 for mortality in our patients according to the mSTESS system. The case mortality rate was 1% in our study. Nonconvulsive SE, slowing and abnormal ground on EEG, being stuporous or comatose, having abnormal MRI-CT, and having a comorbid condition were associated with an unfavorable prognosis in SE patients. Conclusion: The mSTESS is a useful and practical scoring system for predicting the prognosis of SE patients. Nonconvulsive SE, slowing and abnormal ground in EEG, being stuporous or comatose, abnormal MRI-CT, and the presence of comorbid conditions indicated poor prognosis of SE in children.
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