Clinical characteristics and outcome in children with convulsive status epilepticus

Abstract

ABSTRACT Background: Status epilepticus (SE) is a serious neurological emergency that is associated with increased morbidity and mortality. There is emerging interest in understanding the clinical characteristics and identification of the prognosis of children with SE. Objective: To identify the clinical profile and prognosis of children presenting by status epilepticus. Methodology: This is a descriptive analytical study carried out on 31 children who presented by convulsive SE and were admitted to the pediatric intensive care unit. Clinical data, Complete blood count, C-reactive protein, erythrocyte sedimentation rate, serum glucose & electrolytes and cerebrospinal fluid analysis were estimated. Magnetic resonance imaging was done to all included children. Results: Most of the children who presented with SE were younger than 5 years of age (45.2% were <2 years and 32.2% were 2-5 years). 74.2% were males and 83.9% had generalized seizures. 29% had SE as a first presentation. 77.4% were known cases of epilepsy. Non epileptic causes included encephalitis (12.9%), febrile convulsion (a typical) (6.5%) and acute hypoxia (shocking) (3.2%). The main precipitating factors for SE were missing doses in 29%, acute febrile Illness in 12.9%, acute hypoxia in 6.5%, while precipitating factors could not be identified in 41.9% of children. Most children had normal MRI (64.5%). The commonest abnormalities were diffuse hypoxia and encephalitis (12.9% for each). 70.9% of children survived without neurological sequeals, 19.4% developed neurological sequels while 9.7% died. Non-epileptic etiology, febrile illness, hypoxia, elevated acute phase reactant (erythrocytes sedimentation rate and C-reactive protein) was significantly associated with poor outcome. Conclusion: Despite that epilepsy is the main cause of SE, non-epileptic causes are more serious and are associated with a worser outcome. Male gender, poor compliance to antiepileptic medications and febrile illness are linked to the development of SE in children. SE induced by hypoxia and encephalitis had the highest morbidity and mortality.