Refractory Convulsive Status Epilepticus in Children: Etiology, Associated Risk Factors and Outcome
Iranian Journal of Child Neurology,
Vol. 9 No. 4 (2015),
8 October 2015
,
Page 24-31
https://doi.org/10.22037/ijcn.v9i4.7173
Abstract
How to Cite This Article: Barzegar M, Mahdavi M, Zalegolab behbehani A, Tabrizi A. Refractory Convulsive Status Epilepticus in Children: Etiology, Associated Risk Factors and Outcome. Iran J Child Neurol. Autumn 2015;9(4): 24-31.
Abstract
Objective
Refractory status epilepticus (RSE) is a life-threatening disease in children wherein the patient’s convulsive seizures do not respond to adequate initial anticonvulsants. RSE is associated with high rate of mortality and morbidity.
This study was aimed to survey the risk factors leading status epilepticus (SE) to RSE in children, and their early outcome.
Materials & Methods
Patients with SE hospitalized in Tabriz Children’s Hospital, Iran were studied during the years 2007 and 2008 with regard to their clinical profile, etiology, the treatment methods available to them and their outcome upon release from the hospital.
Results
Among 132 patients with SE, 53 patients (40.15%) suffered from RSE. Acute symptomatic etiology was a risk factor responsible for developing RSE in the patient (P=0.004). Encephalitis was the most common etiology of acute symptomatic SE. There was no significant relationship observed between RSE and the patients’ age, gender, date of initial drug intake and type of seizure. The mortality rate was 8.3% and a new neurological deficit occurred in 25.7% of cases. None of RSE with encephalitis returned to the baseline status. Mortality and morbidity rates were significantly higher in children with RSE than in those
with SE (P=0.006).
Conclusion
Etiology of SE significantly influenced prognosis of it with significant incidence of RSE in acute symptomatic group. Because acute neurological insult such as encephalitis and meningitis are common causes of RSE in children, properly management of them is necessary to avoid permanent brain damage.
- Refractory status epilepticus
- Etiology
- Mortality
- Morbidity
- Children
How to Cite
References
Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines on epidemiologic studies on epilepsy. Epilepsia1993; 34(4): 592-596.
Mitchell WG. Status epilepticus and acute repetitive seizures in children, adolescent, and young adults: etiology, outcome, and treatment. Epilepsia1996; 37(11):74-80.
Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 2006; 368:222–229.
Saz EU, Karapinar B, Ozcetin M,Polat M, Tosun A,Serdaroglu G, etal Convulsive status epilepticus in children: Etiology, treatment protocol and outcome. Seizure 2011;20:115-118.
Raspall-ChaureM, Chin RFM, Neville BG, Scott RC. Outcome of pediatric convulsive status epilepticus: a systematic review. Lancet Neurol. 2006; 5: 769-79.
Hussain N, Appleton R, Thorburn K, Etiology, course and outcome of children admitted to pediatric intensive care with convulsive status epilepticus: A retrospective 5-year review. Seizure 2007; 16: 305-312.
Lambrechtsen F, Buchhalter J. Aborted and refractory status epilepticus in children:A comparative analysis. Epilepsia 2008;49(4):615-625.
Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatr 2005; 76:534-539.
Chin RF, Neville BG, Scott RC. A systematic review of epidemiology of status epilepticus. Eur J Neurol 2004;11:800-810.
Mayer SA, Claasen J, Lokin J, Mendelson F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factor and impact on outcome. Arch Neurol 2002;59:205-210.
Ferna´ndez IS, Abend NS, Agadi S, An S, Arya R, Carpenter JL et al. Gaps and opportunities in refractory status epilepticus research in children: A multi-center approach by the Pediatric Status Epilepticus Research Group (PSERG). Seizure 2014; 23: 87-97.
Sahin M, Menache CC, Holmes GL, Riviello JJ. Outcome of severe refractory status epilepticus in children. Epilepsia 2001; 42:1461-1467.
Kang DC, Lee YM, Lee JS, Kim HD, Coe CJ.Prognostic factors of status epilepticus in children.Yonsei Med J 2005;46(1):27-33.
Classen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. J Neurol Sci 2003;211:37–41.
Pellock JM, Deorenzo RJ..Status epileptcu. In :Swaiman KF, Ashwal S, ferriero DM, Schor NF.Swaiman,s Pediatric Neurology Principles and Practice.5th ed New York Elsevier 2012 p:798-810.
Maytal J, Shinar S, Moshe SL, Alvarez LA. Low mortality and morbidity of status epilepticus in children. Pediatrics 1989;83:323-231.
Logroscino G, Hesdorffer DC, Cascino G, Annegers JF, Hauser WA. Time trends in incidence, mortality, and case fatality after first episode of status epilepticus. Epilepsia 2001; 42:1031–1035.
Phillips SA, Shanahan RJ, Etiology and mortality of status epilepticus in children- a recent update. Arch Neurol 1989;46:74-76.
Shinnar S, Maytal J, Krasnoff L Moshe SL Recurrent Status epilepticus in children. Ann Neurol 1992; 31:701-706.
Barzegar M, JafariRoohi AH. Refractory status epilepticus in children; risk factors, management and early outcome. Journal of Shaheed Sadoughi University of Medical Sciences and Health Servieces 2008; 15(4): 16-20.
Garzon E, Fernandes RM, Sakamoto AC. Analysis of clinical characteristics and risk factor for mortality in human status epilepticus Seizure 2003, 12:337-345.
Komur M, Arslankoylu AE, Okuyaz C, Keceli M, Derici D. Management of Patients With Status Epilepticus Treated at a Pediatric Intensive Care Unit in Turkey. Pediatr Neurol 2012; 46: 382-386.
Kwong KL, Chang K, Lam sy. Features predicting advers outcomes of status epilepticus in childhood. Hong Kong Med 2004;10:156-159.
Ozdemir D, Gulez P, Uran N, Yendur G, Kavakli T, Aydin A. Efficacy of contious midazolam infusion and mortalty in childhood refractory generalized convulsive status epilepticus. Seizure 2005;14:129-32.
Morrison G1, Gibbons E, Whitehouse WP. High-dose midazolam therapy for refractory status epilepticus in children Intensive Care Med 2006 Dec;32(12):2070-6.Epub 2006 Sep 15.
Claassen J, Hirsch L, Emerson R, Mayer S. Treatment of refractory status epilepticus with pentobarbital, propofol or midazolam. A systematic review. Epilepsia 2002,43:146-153.
Holtkamp M, Masuhr F, Harms L, Einhäupl KM, Meierkord H, Buchheim K. The management of refractory generalised convulsive and complex partial status epilepticus in three European countries: a survey among epileptologists and critical care neurologists. J Neurol Neurosurg Psychiatr 2003; 74:1095-9.
Gilbert DL, glauser TA. Complications and costs of treatment of refractory generalized status epilepticus in children. J Child Neurol. 1999;14:597-602.
Brevood JC, Joosten KF, Arts WF, van Rooij RW, de Hoog M. Status epilepticus: clinical analysis of a treatment protocol based on midazolam and phenytoin. J Child Neurol 2005; 20:476-81.
Lin JJ, Lim KL, Wang HS, Hsia SH and Wu CT. Analysis of status epilepticus related presumed encephalitis in children. Eur J Ped Neurol 2008, 12:32-37.
- Abstract Viewed: 639 times