Chapter 46 - Status epilepticus in children

Abstract

Status epilepticus (SE) is common, especially in children less than 2years old. In young children, status occurs primarily in those who are neurologically normal and with no prior history of seizures. Prolonged febrile seizures and acute symptomatic seizures are the most common causes of SE in this age group. In older children, SE occurs primarily in those who have a history of epilepsy and who are also neurologically abnormal. Initiation of treatment is recommended after 5–10 minutes of seizure activity and begins with the early use of benzodiazepines. The morbidity and mortality of SE are low and are primarily a function of the underlying etiology. The development of cognitive deficits following an episode of SE not associated with an acute or progressive central nervous system insult is unusual. The risk of future epilepsy is also not increased in children with cryptogenic SE when compared with those with a single brief cryptogenic seizure. Febrile status alone is not a risk factor for future epilepsy, but there is an increased risk of epilepsy in those whose febrile seizures were both prolonged and focal; however, this risk may be the result of the presence of pre-existing pathology predisposing to prolonged focal febrile seizures.