Disease spectrum of nonconvulsive status epilepticus in children: A study based on clinical subtype characteristics...

To investigate risk factors affecting the short- and long-term prognosis of pediatric status epilepticus (SE) complicated by nonconvulsive status epilepticus (NCSE) during the disease course and to analyze the clinical heterogeneity of this group to effectively identify population characteristics and subgroups influencing prognosis.

This study is a single-center retrospective cohort study. Clinical data from 215 pediatric patients diagnosed with SE at Chongqing Medical University Children's Hospital between February 2005 and September 2024, who met the diagnostic criteria for NCSE during their illness, were included. Univariate analysis and multivariate logistic regression were employed to identify factors associated with short-term and long-term adverse outcomes. Hierarchical cluster analysis was conducted based on clinical characteristics.

The in-hospital mortality rate was 3.3% (7/215), increasing to 6.0% (12/200) in long-term follow-up. The short-term poor prognosis rate was 29.8% (64/215), while the long-term poor prognosis rate was 20.5% (41/200). Multivariate analysis revealed that independent risk factors for poor short-term prognosis included GCS scores of 3-8, global developmental delay, interictal EEG showing periodic discharges, and diffuse MRI abnormalities. Poor long-term prognosis was primarily associated with GCS scores of 3-8, global developmental delay, and electroclinical syndromes. Further clinical phenotype clustering analysis revealed four heterogeneous subgroups: super-refractory subgroup (characterized by profound impaired consciousness and diffuse brain injury), young-age metabolic subgroup (age < 24 months with multifocal abnormalities), focal structural subgroup (manifesting as focal neurological deficits and structural etiology), and benign reactive subgroup (mild altered consciousness and treatment sensitivity).

Level of consciousness, electroencephalogram (EEG), neurodevelopmental status, and electroclinical syndromes can serve as core indicators for prognostic stratification in children with NCSE; subtyping based on clinical features can effectively distinguish heterogeneous subgroups, providing a clinical phenotypic basis for individualized stratified diagnosis, treatment, and prognostic assessment of pediatric NCSE, thereby addressing the current lack of a multidimensional stratification framework in clinical practice.