Abstract
ObjectivesThe main aim is to find out the clinical feature and outcome of status epilepticus (SE) in children managed in a teaching hospital. The secondary aim is to identify the risk factors influencing the adverse outcomes.MethodsIn this prospective cohort, children aged 1 month to 14 years with SE as per the International League Against Epilepsy’s new guideline (2016) who presented to the emergency department during the period of November 2017 to October 2019 were enrolled. Clinical profile, treatment, and outcome of cases (n = 94) were noted.ResultsThe majority of children, 60 (63.82%), were less than five years of age. Prior history of seizures was present in 33 (35.1%) cases, whereas 61 (64.9%) cases presented with SE as the first episode of seizure. In 14 (42.4%) previous seizure cases, SE was due to drug default. No response to first-line antiepileptic drug (AED) was seen in 84 (89.37%) cases. Acute symptomatic etiology was the commonest etiology of SE in 64 (68%) cases, of which neuro-infections accounted for 44 (46.80%) cases. Longer duration (>60 minutes) of status (p < 0.01), ventilator support (p < 0.0001), and circulatory impairment (p < 0.0001) were attributable risk factors for mortality. A total of 28 children died (mortality rate, 29.8%), and 11 showed the persistence of their neuro-deficit.ConclusionsNeuro-infection is the most common etiology of SE in children. Longer duration of SE, more lag time for receiving the first AED, respiratory failure, and presence of shock are independent predictors for poor outcome. Hence, cessation of convulsion at the earliest leads to improved outcomes.
Highlights
Status epilepticus (SE) is a medical emergency, and its neurological outcome is a concern to every pediatrician in developing countries
The main aim is to find out the clinical feature and outcome of status epilepticus (SE) in children managed in a teaching hospital
Acute symptomatic etiology was the commonest etiology of SE in 64 (68%) cases, of which neuro-infections accounted for 44 (46.80%) cases
Summary
Status epilepticus (SE) is a medical emergency, and its neurological outcome is a concern to every pediatrician in developing countries. It is documented that if convulsion persisted beyond 10 minutes, it leads to irreparable brain damage and difficulty in controlling the seizure [4]. It is of paramount importance to control seizure activity within 5-10 minutes to prevent neuronal damage. Benzodiazepines (BZD) are the first-line drugs to control seizure within 5-10 minutes of convulsion [5,6]. It should be followed by second-line drugs in the 10-20 minutes. If the convulsion does not get control, third-line drugs such as anesthetic medicines through continuous infusion should be given within 30-60 minutes [6]
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