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Admissions to a pediatric intensive care unit for status epilepticus: a 10-year experience
J Lacroix1, C Deal, M Gauthier
1Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Canada.
Insights
Status epilepticus in children is often caused by epilepsy or infections like meningitis. While most survivors recover well, especially those with normal prior development, some experience lasting neurological issues.
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 causes, outcomes, and prognostic factors of pediatric SE is crucial for effective management.
Purpose of the Study:
- To investigate the etiology, clinical course, and prognosis of pediatric patients admitted to the intensive care unit (ICU) for status epilepticus.
- To identify factors associated with morbidity and mortality in pediatric SE.
Main Methods:
- Retrospective, descriptive study conducted in a pediatric ICU at a university hospital.
- Analysis of 153 episodes of status epilepticus in 147 children (0-16 years) over a 10-year period.
- Data collection included etiology, seizure characteristics, interventions, and neurological outcomes.
Main Results:
- The most common causes of SE were epilepsy (35%), atypical febrile convulsions (14%), bacterial meningitis (14%), encephalitis (14%), and metabolic disorders (8%).
- The in-hospital mortality rate was 6%. Among previously normal children, 26% developed new neurological problems, with 68% of those still affected at 1 year.
- A normal neurological status prior to SE and age under 4 years were associated with a good prognosis, while encephalitis and meningitis indicated poorer outcomes.
Conclusions:
- Epilepsy, febrile seizures, meningitis, encephalitis, and metabolic disorders are leading causes of pediatric SE.
- The mortality rate during ICU stay was 6%, with most deaths attributed to underlying conditions.
- Prognosis is generally favorable for survivors, particularly in children with normal pre-SE neurological development.
Objective:
To characterize the etiology, course, and prognosis in children admitted to a pediatric intensive care unit (ICU) for status epilepticus.
Design:
Retrospective, descriptive study.
Setting:
Pediatric ICU in a university hospital.
Patients:
One hundred forty-seven children admitted with status epilepticus.
Interventions:
None.
Measurements And Main Results:
Status epilepticus was defined as a prolonged (> 30 mins) or repeated tonic or tonic-clonic seizure with a persistent altered state of consciousness. Over 10 yrs, 147 children 0 to 16 yrs of age (median 1; mean 3.4 +/- 3.9 [SD]) were admitted to a pediatric ICU for, or with, 153 episodes of status epilepticus. Status epilepticus was caused most often by epilepsy (n = 52), atypical febrile convulsions (n = 21), bacterial meningitis (n = 20), encephalitis (n = 20), intoxication (n = 8), or a metabolic disorder (n = 12). Two infants, 1 and 3 months of age, and a patient with intoxication by isoniazid, responded to pyridoxine. Among 114 previously normal children, 34 patients displayed a new neurologic problem on discharge from the ICU, among whom, 68% (23/34) still had some neurologic abnormality 1 yr after the episode of status epilepticus. Nine patients died during their ICU stay, mostly from underlying disease rather than from the status epilepticus itself. A normal neurologic status before status epilepticus and age < 4 yrs seem to be markers of good prognosis, while encephalitis and meningitis appear to be markers for morbidity and mortality.
Conclusions:
Most cases of status epilepticus were caused by epilepsy, atypical febrile seizure, encephalitis, meningitis, or metabolic disease. The mortality rate during the ICU stay was 6%. The prognosis was good in most surviving cases, more so if the neurologic development of the child was normal before the status epilepticus.