Abstract
SummaryBackgroundConvulsive status epilepticus (CSE) is the most common neurological emergency in childhood and is often associated with fever. In sub-Saharan Africa, the high incidence of febrile illnesses might influence the incidence and outcome of CSE. We aimed to provide data on the incidence, causes, and outcomes of childhood CSE in this region.MethodsBetween March, 2006, and June, 2006, we studied all children who had been admitted with CSE to a Kenyan rural district hospital in 2002 and 2003. Confirmed CSE had been observed directly; probable CSE was inferred from convulsions on arrival, requirement for phenobarbital or phenytoin, or coma with a recent history of seizures. We estimated the incidence with linked demographic surveillance, and risk factors for death and neurological sequelae were analysed by multivariable analysis.FindingsOf 388 episodes of CSE, 155 (40%) were confirmed CSE and 274 (71%) were caused by an infection. The incidence of confirmed CSE was 35 (95% CI 27–46) per 100 000 children per year overall, and was 52 (21–107) and 85 (62–114) per 100 000 per year in children aged 1–11 months and 12–59 months, respectively. The incidence of all CSE was 268 (188–371) and 227 (189–272) per 100 000 per year in these age-groups. 59 (15%) children died in hospital, 81 (21%) died during long-term follow-up, and 46 (12%) developed neurological sequelae. Mortality of children with confirmed CSE while in hospital was associated with bacterial meningitis (adjusted relative risk [RR]=2·6; 95% CI 1·4–4·9) and focal onset seizures (adjusted RR=2·4; 1·1–5·4), whereas neurological sequelae were associated with hypoglycaemia (adjusted RR=3·5; 1·8–7·1) and age less than 12 months (adjusted RR=2·5; 1·2–5·1).InterpretationPrevention of infections and appropriate early management of seizures might reduce the incidence and improve the outcome of CSE in children in sub-Saharan Africa.
Highlights
Convulsive status epilepticus (CSE) is the most common childhood neurological emergency in developed countries and can lead to neurocognitive sequelae and death.[1,2] The incidence of CSE in London, UK, has been reported as 18–20 per 100 000 per year in children of less than 16 years old, with higher rates in the first few years of life.[3]
Mortality of children with confirmed CSE while in hospital was associated with bacterial meningitis and focal onset seizures, whereas neurological sequelae were associated with hypoglycaemia and age less than 12 months
19% (18/95) of children with CSE associated with fever had a CNS infection; acute bacterial meningitis was common and was associated with a higher risk of mortality.[3]
Summary
Convulsive status epilepticus (CSE) is the most common childhood neurological emergency in developed countries and can lead to neurocognitive sequelae and death.[1,2] The incidence of CSE in London, UK, has been reported as 18–20 per 100 000 per year in children of less than 16 years old, with higher rates in the first few years of life.[3]. In the London study, one third of childhood CSE was attributable to febrile seizures with a benign short-term outcome.[3] 19% (18/95) of children with CSE associated with fever had a CNS infection; acute bacterial meningitis was common and was associated with a higher risk of mortality.[3] Seizures with fever are common in children admitted to hospitals in sub-Saharan Africa,[5] in malaria-endemic areas where CSE is well recognised. Socioeconomic deprivation and non-white ethnic origin were independently associated with an increased incidence of CSE in the London study (Chin R, personal communication). These factors suggest a higher incidence would be expected in sub-Saharan Africa than in London. Restricted access to antiepileptic drugs, parenteral phenobarbital,[6] might lead to higher mortality and morbidity in this region
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