Childhood convulsive status epilepticus

Abstract

Richard Chin and colleagues' study (July 15, p 222)1Chin RF Neville BG Peckham C et al.Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study.Lancet. 2006; 368: 222-229Summary Full Text Full Text PDF PubMed Scopus (401) Google Scholar is an excellent springboard for future research into childhood convulsive status epilepticus (CSE). It would be further improved if details of the method of seizure analysis were published. This would assist others who might wish to replicate this study. The validity of naming seizures as focal or generalised has been questioned in this journal,2Faught E Naming seizures.Lancet. 2005; 366: 1251-1252Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar but I presume that, by generalised CSE, Chin and colleagues mean “no evidence of focal onset”. Most remarkable to me is the finding of only two instances of clonic CSE in 176 children with first-ever CSE, compared with 151 with tonic-clonic CSE. This is very different from the case in anoxic-epileptic seizures (AES)—ie, epileptic seizures induced by syncopes—where the epileptic component is almost always clonic.3Stephenson J Breningstall G Steer C et al.Anoxic-epileptic seizures: home video recordings of epileptic seizures induced by syncopes.Epileptic Disord. 2004; 6: 15-19PubMed Google Scholar, 4Horrocks IA Nechay A Stephenson JBP Zuberi SM Anoxic-epileptic seizures: observational study of epileptic seizures induced by syncopes.Arch Dis Child. 2005; 90: 1283-1287Crossref PubMed Scopus (68) Google Scholar, 5Nechay A Smulska N Chepiga L Anoxic-epileptic seizures in Cornelia de Lange syndrome: case report of epileptic seizures induced by obstructive apnea.Eur J Paediatr Neurol. 2006; 10: 142-144Summary Full Text Full Text PDF PubMed Scopus (11) Google Scholar When CSE complicates AES (as it often does) it is also mostly generalised clonic.4Horrocks IA Nechay A Stephenson JBP Zuberi SM Anoxic-epileptic seizures: observational study of epileptic seizures induced by syncopes.Arch Dis Child. 2005; 90: 1283-1287Crossref PubMed Scopus (68) Google Scholar How do Chin and colleagues define tonic-clonic as opposed to clonic? Exact observation of the nature of a first episode of CSE must be difficult for families. What were the techniques of history-taking used? For example, were parents shown videos of clonic epileptic seizures (such as have been published3Stephenson J Breningstall G Steer C et al.Anoxic-epileptic seizures: home video recordings of epileptic seizures induced by syncopes.Epileptic Disord. 2004; 6: 15-19PubMed Google Scholar) for comparison with tonic-clonic CSE? Precise descriptions of semiology underpin genetic advances in childhood paroxysmal disorders, and the same must surely apply to epidemiological advances. I declare that I have no conflict of interest. Childhood convulsive status epilepticus – Authors' replyThe standardised admission proforma used in our study is available on request from the corresponding author and was used in the hospital notes as part of the primary record. It included a detailed description of the seizures, including whether the onset was focal and whether there were any focal features during the event. Full-Text PDF