Intractable convulsion in critically ill children

Abstract

Introduction: To determine the etiology of intractable convulsion, the outcome of intractable convulsions in pediatric patients and risk factors related to poor outcome. Material and methods: This case-control study conducted on 100 children where 50 patients who fulfilled the criteria for intractability admitted into pediatric intensive care unit (PICU) and 50 epileptic children on appropriately chosen antiepileptic drug (AED) with no seizures for more than 1 year who attending to the pediatric neurology clinic for follow up. Full history taking, examination, investigations performed for patients groups on admission and then followed up to six months for an outcome. Results: This study showed no significant difference between studied groups as regard age, sex, consanguinity and positive family history but noticed a highly statistically significant increase in prenatal problems (n; 20 patients), neonatal seizure (n; 15 patients), and postnatal problem (n; 10 patients) in intractable groups compared to controlled groups (p value 0.001).Delayed developmental history (n; 40 patients) was significantly higher among intractable groups compared to controlled groups (p value 0.001).Intractable groups had significantly increased in abnormal neurological examination than controlled groups (p value 0.001).History of prenatal problems, neonatal seizures, delayed developmental milestones, presence of underlying etiology of seizures, and abnormality findings in EEG and neuroimaging are risk factors for the intractability of convulsion. There was a significant relation between poor outcome and other studied variables including being female, presence of consanguinity, delayed developmental milestones, disturbed level of consciousness and secondary etiology of seizures (p value; 0.04, 0.003, 0.001, 0.001 0.001 respectively). Conclusion: The most common etiology of intractability in epileptic children is a secondary etiology of seizures. Early detection of risk factors for intractable epilepsy is important to decrease intractability complications. Proper perinatal care is important for decreasing prevalence of intractable epilepsy.