Cause Of Convulsive Status Epilepticus Research Articles

Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments

ObjectiveFunctional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired. MethodsWe retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure. ResultsThe 206 women and 293 men had a median age of 59 years [47–70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P < 0.0001), similar ICU mortality (19.6 vs. 13.1, P = 0.22), higher 1-year mortality (39.3% vs. 25.6%, P < 0.01), and a similar proportion of patients with no worsening of the GOS score at 1 year (42.9 vs. 44.1, P = 0.89). By multivariate analysis, not achieving a favorable 1-year outcome was associated with age above 59 years (OR, 2.36; 95%CI, 1.55–3.58, P < 0.0001), preexisting ultimately fatal comorbidity (OR, 2.92; 95%CI, 1.71–4.98, P = 0.0001), refractory CSE (OR, 2.19; 95%CI, 1.43–3.36, P = 0.0004), cerebral insult as the cause of CSE (OR, 2.75; 95%CI, 1.75–4.27, P < 0.0001), and Logistic Organ Dysfunction score ≥ 3 at ICU admission (OR, 2.08; 95%CI, 1.37–3.15, P = 0.0006). A preadmission GOS score of 3 was not associated with a functional decline during the first year (OR, 0.61; 95%CI, 0.31–1.22, P = 0.17). SignificancePreadmission functional status in adult patients with CSE is not independently associated with a functional decline during the first postadmission year. This finding may help physicians make ICU admission decisions and adult patients write advance directives.Study Registration: #NCT03457831.

Clinical profile and comparison of scoring tools for the prediction of in-hospital mortality in convulsive status epilepticus in elderly

PurposeThe present study was aimed to study the clinical profile, etiologies, and outcome of convulsive status epilepticus (CSE) in elderly patients and also to compare the predictive accuracy of the Status Epilepticus Severity Score (STESS) and Epidemiology-based Mortality Score in Status Epilepticus — etiology, age, level of consciousness (EMSE-EAL) score for in-hospital mortality. MethodsEighty-five elderly patients (≥60 years of age) with a diagnosis of CSE were consecutively enrolled. The distinction between the score performances was determined by comparing the means area under the receiver operating characteristic curve (AUC). ResultsThe mean age of respondents was 66.3 ± 7.4 years; the most common etiology of CSE was stroke (acute and remote symptomatic) in 48.2% of cases. In-hospital mortality was 16.5% in our series, and on multivariate analysis, variables significantly related with mortality were lack of response to first-line drugs (odds ratio (OR) = 43.05, 95% confidence interval (CI) = 4.7–386.8; p = .001) and higher EMSE-EAL score (OR = 0.08, 95% CI = 0.015–0.47; p = .005). On comparison, STESS with the cutoff value of ≥3 has AUC of 0.678 (95%CI = 0.54–0.81), whereas ESME-EAL with the cutoff value of ≥40 showed AUC of 0.901 (95% CI = 0.83–0.97). ConclusionsMost frequent cause of CSE in elderly in our series was stroke and was also associated with high mortality. For the prediction of in-hospital mortality in elderly, EMSE-EAL-40 score is superior to STESS-3, which can be easily applied in resource-poor sectors with limited diagnostic facilities especially where continuous video-electroencephalogram (EEG) monitoring is unavailable.

Immediate Treatment Outcome of Convulsive Status Epilepticus Following a Specific Management Protocol

Background: Status epilepticus (SE) is a medical and neurologic emergency. Rapid and aggressive treatmentis required to prevent neuronal damage, systemic complications and death. Standardized treatment guidelines may improve the quality of emergency managementof SE.&#x0D; Objectives: The objective of the present study was to assess under lying causes of seizure and the immediate outcome of treatment following the specific proposed management protocol care.&#x0D; Methodology: This cross-sectional study was undertaken on 94 consecutive cases admitted inPediatrics department of Dhaka Medical College Hospital, Dhaka diagnosed as convulsive status epilepticus, age&lt;15 years from September, 2012 – February, 2013. Cases were treated with specific institutional protocol. Under lying causes, outcome of the treatment and side effects of the drugs used were analyzed.&#x0D; Results: Among 94 cases, most of the patients belonged to 6 months - 5 years (73.34%), M: F was1.17:1. The leading presenting features were fever (75.53%), headache (36.17%), meningeal irritation (22.34%).Major causes of convulsive status epilepticus were febrile convulsion (42.6%), meningitis (22.3%), and epilepsy (21.3%), more than two-third (71%) had GTCS, 29% had focal seizure. Most of them presented within 6 hours of convulsion and nearly half of the patient responded to per-rectal diazepam with complete recovery and without any residual problems. A very few cases developed immediate or late behavioral problems or residual neurological deficit like hemiplegiaand epilepsy.&#x0D; Conclusion: Establishing causative factors and early intervention with specific treatment protocol can make rapid seizure control with better outcome.&#x0D; Journal of National Institute of Neurosciences Bangladesh, 2019;5(1): 33-37

Convulsive status epilepticus in children: clinical profile and outcome in a tertiary care hospital

Background: The outcome of status epilepticus (SE) depends on various determinants such as age, type and duration of SE, etiology, management and associated comorbidities. This study was undertaken to describe the clinical profile and outcome of children with convulsive status epilepticus presenting to pediatric intensive care unit (PICU).Methods: Eighty-seven children between the age group 1 month to 12 years who at presentation or during the PICU stay had convulsive status epilepticus (CSE) were included in the study. Clinical profile, etiological spectrum and outcome at the end of hospital stay were analysed.Results: Median age of CSE was 4 years and 55 (63.2%) were below 5 years of age. Acute symptomatic etiology of CSE was a significant risk factor (p= 0.03) for refractory status epilepticus (RSE) which was seen in 31 patients (39%). Acute symptomatic etiology was the cause of CSE in 46 (59.2%) children. Remote symptomatic (26.4%), cryptogenic (18.4%) and progressive (2.3%) were other etiologies. Neuro-infection (29.8%) and febrile seizures (11.5%) were the most common acute symptomatic causes. Mortality and morbidity occurred in 23 (26.4%) and 8 (9.2%) patients respectively. Remaining 56 (64.6%) returned to baseline condition at the end of hospital stay. Longer duration (p= 0.03) and acute symptomatic etiology (p=0.049) were significant risk factors for mortality.Conclusions: Most common causes of CSE in children are acute symptomatic. Longer duration of status is associated with higher mortality. Hence, termination of seizure activity at the earliest, prudent management of respiratory or circulatory impairments in these children and improving the overall health care to prevent neuro-infections are important steps to improve outcome.

Adult convulsive status epileptic us: clinical, etiological, and predictors of outcome study from rural population of North India

Aim: To determine the clinical profile, etiologies and predictors of mortality in patients with convulsive status epilepticus (CSE) among rural population of North India in view of limited published data on epidemiology and etiology of status epilepticus (SE) from developing countries.Methods: One hundred sixty-two consecutive adult patients with CSE were evaluated from 2016 to 2018 for demographic profile, etiologies and predictors of poor outcome.Results: The mean age was 41.71 ± 19.72 years. Most of the CSE cases were acute symptomatic (48.8%) type with central nervous system (CNS) infections (24.1%) being the predominant precipitating factor. Antiepileptic drugs (AEDs) noncompliance accounted for 34.9% of the cases with pre-existing epilepsy. The median duration of CSE was 5.5 h (IQR-3-10 h). 82.1% cases responded to the first line drugs and their response was related with duration of CSE (p = .0045). Case fatality was 16.0% and the predictors of the mortality were; low Glasgow Coma Scale (GCS) (OR =9.64, 95% CI= 2.064–45.02; p = .0001), lack of response to first line drugs (OR =0.019, 95% CI= 0.003–0.11; p = .0001) and absence of past history of epilepsy (OR =0.525, 95%CI =0.104–2.66; p = .004).Conclusions: CNS infection and AEDs noncompliance were identified to be the major cause of CSE which can be potentially preventable. Present study signifies that prompt and successful control of infections appears to be the most efficient preventive approach. Level of consciousness as a potential predictor of poor outcome can be quickly accessible to the treating clinician in optimizing treatment strategies.

Cardiac Arrest in Patients Managed for Convulsive Status Epilepticus: Characteristics, Predictors, and Outcome.

Cardiac arrest is a catastrophic event that may arise during the management of convulsive status epilepticus. We aimed to report the clinical characteristics, outcomes, and early predictors of convulsive status epilepticus-related cardiac arrest. Retrospective multicenter study. Seventeen university or university affiliated participating ICUs in France and Belgium. Consecutive patients admitted to the participating ICUs for management of successfully resuscitated out-of-hospital cardiac arrest complicating the initial management of convulsive status epilepticus between 2000 and 2015. Patients were compared with controls without cardiac arrest identified in a single-center registry of convulsive status epilepticus patients, regarding characteristics, management, and outcome. None. We included 49 cases with convulsive status epilepticus-cardiac arrest and 235 controls. In the cases, median time from medical team arrival to cardiac arrest was 25 minutes (interquartile range, 5-85 min). First recorded rhythm was asystole in 25 patients (51%) and pulseless electrical activity in 13 patients (27%). A significantly larger proportion of patients had a favorable 1-year outcome (Glasgow Outcome Scale score of 5) among controls (90/235; 38%) than among cases (10/49; 21%; p = 0.02). By multivariate analysis, independent predictors of cardiac arrest were pulse oximetry less than 97% on scene (odds ratio, 2.66; 95% CI, 1.03-7.26; p = 0.04), drug poisoning as the cause of convulsive status epilepticus (odds ratio, 4.13; 95% CI, 1.27-13.53; p = 0.02), and complications during early management (odds ratio, 11.98; 95% CI, 4.67-34.69; p < 0.0001). Having at least one comorbidity among cardiac, respiratory, and neurologic (other than epilepsy) conditions predicted absence of cardiac arrest (odds ratio, 0.28; 95% CI, 0.10-0.80; p = 0.02). In patients managed for convulsive status epilepticus, relative hypoxemia, on-scene management complications, and drug poisoning as the cause of convulsive status epilepticus were strong early predictors of cardiac arrest, suggesting areas for improvement.

Clinical profile and outcome of refractory convulsive status epilepticus in older children from a developing country

PurposeThe current study evaluates the etiology, clinical course and outcome of refractory convulsive status epilepticus (CSE) in older children. MethodsRetrospective analysis of data of 73 children with CSE, aged ≥2 and ≤12 years was performed. Odds ratios were calculated between variables for clinical course and outcome. Mortality of the group was analyzed using survival analysis. ResultsThirty three (45.2%) children progressed to refractory status epilepticus (RSE). The most common etiology for CSE was acute symptomatic in 44 (60.3%) of which 37 had presumed CNS infections. The odds of progressing to RSE were higher in children with acute symptomatic etiology (OR 2.62; CI – 95%; 0.99–7.14; p=0.041). Progression to RSE increased the chances of severe sepsis by six times (OR 6.08; CI – 95%; 1.19–31.02; p=0.036) and acidosis by nearly 15 times (OR 14.77; CI – 95%; 1.19–31.02; p=0.020). Overall mortality was 13.7%, higher in RSE (21.2% vs.7.5%). Amongst the 63 surviving children followed for 1 year from discharge, progression to RSE increased the odds of disability by seven times (OR 7.08; CI 29.31; p=0.004). ConclusionAcute symptomatic etiology was the commonest cause of CSE among older children from developing country and increased the odds of progressing to RSE. RSE was significantly associated with disability at 1 year from discharge.

Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital.

Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality.

The aetiology of convulsive status epilepticus: A study of 258 cases in Western China

PurposeTo investigate the characteristics of the aetiologies of convulsive status epilepticus (CSE) in Western China and to identify the relationships of these aetiologies with the prognoses. MethodsConsecutive registration and prospective observation of 258 cases of CSE in the Sichuan Epilepsy Center were performed from 1996 to 2010 to study the aetiology of CSE. The relationships of the aetiologies with the demographics, outcomes and complications of CSE were analysed using a logistic regression model. ResultsThe mean age was 37.6±20.21 years. The majority of the CSE (62.4%) cases were acute symptomatic cases, and the primary cause was central nervous system (CNS) infection (33.7%). Histories of epilepsy were present in 51.9% of the patients. Pre-existing epilepsy occurred due to discontinuation or reduction of antiepileptic drugs (AEDs) in 31.3% of the CSE patients. Anoxia/poisoning (p<0.05, OR 8.0, 95% CI 1.34–47.77) was an independent predictor of mortality. CNS infections (p<0.001, OR 8.99, 95% CI 3.52–22.92), cerebrovascular diseases (p =0.001, OR 6.75, 95% CI 2.11–21.61) and anoxia/poisoning (p<0.01, OR 7.64, 95% CI 1.93–30.21) were the major risk factors for complications associated with CSE. Conclusions(1) Compared to developed countries, CNS infections seemed to be more likely to be the cause of CSE in developing countries. (2) Noncompliance with AEDs among patients with epilepsy was a prominent and avoidable trigger of CSE.

The aetiology, management and outcome of convulsive status epilepticus in South Western Uganda

<h3>Purpose</h3> Convulsive status epilepticus (CSE) has a high morbidity and mortality in developing countries. This study aims to determine what factors affect the outcome of CSE in Uganda. <h3>Methods</h3> Children with CSE admitted to Mbarara Regional Referral Hospital were consecutively enrolled over 8 weeks in May-June 2011. Data on patient demographics, previous neurodisability, aetiology and management of CSE were gathered. Children were seen at 4-6 weeks after CSE to determine outcome in terms of death, neurological deficit or subsequent epilepsy. <h3>Results</h3> 36 children were included. Average seizure duration was 72.2 hours. Only 22% of children presented within 3 hours of seizure onset, 75% of these were local. Most children had treatment in the community before attending hospital. Most attended a traditional healer or private clinic (neither of which used antiepileptics to treat CSE), only 28% attended government health centres, where diazepam was sometimes given. CSE duration was only 10.1 hours when diazepam was given in the community, vs. 96.6 hours when it was not. 72% of seizures were due to acute symptomatic causes (meningitis or cerebral malaria). 50% seizures were focal. 25% died, these children had a mean seizure duration of 138.7 hours. All deaths were in children with acute symptomatic CSE, and tended to be younger. The duration of seizure was considerably longer in children who died than in children who survived (65.8 hours vs. 42.5 hours) when cause of CSE was controlled by selecting only cases with acute symptomatic CSE. 52% (12/23) of children who were followed up developed a new neurological deficit (mean CSE duration 144.3 hours), including focal motor deficits or movement disorders (47%), learning disability (43%), and behaviour difficulties (9%). 21% of children developed subsequent epilepsy (mean SE duration 416.0 hours). None of the 8 children whose seizures lasted less than 3 hours died or, when known, had subsequent neurological deficits or epilepsy. The average duration of CSE for children who suffered no adverse events was 20.6 hours. <h3>Conclusion</h3> Aetiology and duration of CSE are powerful predictors of outcome. Duration of CSE is modifiable by community education and the use of pre-hospital antiepileptic drugs.

Hypoglycemia-induced convulsive status epilepticus as the initial presentation of primary hepatic carcinoma

Hypoglycemia is a well-known complication of insulinoma and other non-islet-cell tumors like hepatic tumor. In the emergency unit of neurology department, hypoglycemia is an uncommon cause of convulsive status epilepticus. We report a rare case with hypoglycemia-induced convulsive status epilepticus as the initial presentation of primary hepatic carcinoma. The previously healthy 57-year-old male peasant presented with persistent unconsciousness and repeated convulsive seizures. He was later found to have hepatoma related hypoglycemia. This case highlights the importance of blood sugar test in unexplained status epilepticus in the emergency room of neurology department. Intravenous glucose infusion rather than anti-epileptic drugs might be safer and more effective in treating status epilepticus caused by hepatoma related hypoglycemia.

Functional outcome after convulsive status epilepticus

Few outcome data are available about convulsive status epilepticus managed in the intensive care unit. We studied 90-day functional outcomes and their determinants in patients with convulsive status epilepticus. Two hundred forty-eight convulsive status epilepticus patients admitted to 18 intensive care units in 2005-2007 were included in a prospective observational cohort study. The main outcome measure was a Glasgow Outcome Scale score of 5 (good recovery) on day 90. Convulsive status epilepticus occurred out of hospital in 177 (67%) patients, and all but 15 patients were still seizing at medical team arrival. The median time from convulsive status epilepticus onset to anticonvulsant drug initiation was 40 mins (interquartile range, 5-80). Total seizure duration was 85 mins (interquartile range, 46.5-180). Convulsive status epilepticus was refractory in 49 (20%) patients. The most common causes of convulsive status epilepticus were anticonvulsive agent withdrawal (36.4%) in patients with previous epilepsy and stroke (27.7%) in inaugural convulsive status epilepticus. Mechanical ventilation was needed in 210 (85%) patients. On day 90, 42 (18.8%) patients were dead, 87 (38.8%) had marked functional impairments (Glasgow Outcome Scale score, 2-4), and 95 (42.4%) had a good recovery (Glasgow Outcome Scale score, 5). Factors showing independent positive associations with poor outcome (Glasgow Outcome Scale score, <5) were older age (odds ratio, 1.04/year; 95% confidence interval, 1.02-1.05; p=.0005), cerebral insult (odds ratio, 2.70; 95% confidence interval, 1.37-5.26; p=.007), longer seizure duration (odds ratio, 1.72/120 min; 95% confidence interval, 1.05-2.86; p=.03), on-scene focal neurologic signs (odds ratio, 2.08; 95% confidence interval, 1.03-4.16; p=.04), and refractory convulsive status epilepticus (odds ratio, 2.70; 95% confidence interval, 1.02-7.14; p=.045). Ninety days after intensive care unit admission for convulsive status epilepticus, half the survivors had severe functional impairments. Longer seizure duration, cerebral insult, and refractory convulsive status epilepticus were strongly associated with poor outcomes, suggesting a role for early neuroprotective strategies.

Status epilepticus in resource‐poor countries

Status epilepticus is common in patients admitted to hospitals in resource poor countries (RPC). However, there appear to be differences in the epidemiology, aetiology and outcome of status epilepticus in these regions compared to the West, although there is little data from the former regions. RPC countries are those classified by the World Bank as low income or middle-low income countries encompass those situated in the tropical and subtropical regions. The International League Against Epilepsy (ILAE) definition of status epilepticus (ILAE, 1993) is problematic in these areas, since patients often present to health facilities, without adequate documentation of the duration of convulsion. Thus more pragmatic definitions have been developed (Sadarangani et al., 2008). Most studies on status epilepticus in RPC describe convulsive status epilepticus (CSE) (Misra et al., 2008;Sadarangani et al., 2008), since non-convulsive epilepticus is rarely detected in these regions. Although one study non-convulsive status epilepticus was detected in 11% of adults with altered mental status (Narayanan and Murthy, 2007). The incidence of convulsive status epilepticus appears to be higher in RPC than the West, but there has been only one epidemiological study conducted. In this study, the incidence of children fulfilling the ILAE definition of CSE who presented to a Kenyan District General Hospital was 35/100,000/year, with 268/100,000/year in children aged 1-11 months old. The incidence is higher if those with probable epilepsy are also included (35/100,000/year, with 268/100,000/year). These figures are likely to be an underestimate; since many children with CSE are not admitted hospital, either because convulsions are thought to be caused by traditional causes or the children die before they reach hospital. Thus the rate in this area of Kenya is 2-5 times that of similar study in London, United Kingdom (Chin et al., 2006). CSE appears to be more common in children than adults; mainly because acute symptomatic seizures or febrile status epilepticus are more common, particularly in RPC(Sadarangani et al., 2008;Tabarki et al., 2001). A significant proportion of people with epilepsy in RPC have an episode of CSE, usually in childhood and often as the first reported seizure. Thus in a cross-sectional study of active convulsive epilepsy in Kenya, 35% of those identified with active convulsive epilepsy had a history of prolonged seizures (probable CSE), of which 75% were associated with a febrile illness(Edwards et al., 2008). Thus, the high incidence of acute symptomatic epilepsy in many RPC may account for the increased incidence and prevalence of epilepsy in these regions. Most CSE is symptomatic, with the increased incidence attributed to the increased incidence of infections (Misra et al., 2008;Sadarangani et al., 2008). In malaria endemic areas, malaria is an important cause of CSE in children (Sadarangani et al., 2008), whist bacterial meningitis and viral encephalitis are important causes in other areas (Murthy et al., 2007). Patients appear to be in status for longer periods, although there is little reliable data on the duration of CSE in patients presenting to hospital. The increase duration may be due to the lack of treatment prior to admission to hospital, inadequate treatment on admission to hospital and/or a reduction in the responsiveness to the benzodiazepines. The mortality associated with CSE in RPC is greater (11-15%), both in adults (Murthy et al., 2007) and children (Sadarangani et al., 2008); but the long-term outcome in terms of premature mortality and neurocognitive sequelae is undetermined. Risk factors for mortality i.e. young age (< 1 years), aetiology (particularly bacterial meningitis), focal seizures and duration of seizure, are similar to the West. The neuro-cognitive outcome of CSE appears worse with 36% of Tunisian children having intellectual disability or epilepsy (Tabarki et al., 2001). The risk factors for neuro-cognitive impairment include young age (<1 year), focal seizures. Many hospitals in RPC, particularly those in rural areas have few drugs to treat CSE, and many hospitals do not have intensive care facilities such as ventilators or sufficient staff to provide optimal management. The antiepileptic drugs are limited to benzodiazepines, particularly Diazepam and Phenobarbital. However, the response to diazepam appears poorer in many areas, either because the patients present with seizures lasting many hours or possibly the aetiology such as malaria makes them more resistant to these compounds. The treatment of CSE in RPC is further complicated by the lack of rectal preparations of diazepam (parenteral preparation is often used, but has erratic absorption (Ogutu et al., 2002)) and lack of supply of parenteral Phenobarbital (Wilmshurst and Newton, 2005). These issues may affect the outcome. Thus, CSE appears to be more common, with a worse outcome in RPC than in the West; but at present, there is little data on which to base the burden and recommendations of treatment in these countries.

Clinical features of convulsive status epilepticus: a study of 220 cases in western China

Convulsive status epilepticus (CSE) is the most common and life-threatening form of status epilepticus (SE). The aim of this study was to describe the clinical features of CSE in western China. Convulsive status epilepticus patients hospitalized from January 1996 to October 2007 were prospectively observed. Logistic regression was used to identify predictors of prognosis. The average age of CSE patients (n = 220) was 37.5 years (SD 20.31), 50% of the patients had a history of epilepsy. The primary cause of CSE was central nervous system infection (32.7%), followed by discontinuation or reduction of antiepileptic drugs (AEDs; 15.5%). The median duration of CSE was 5 h and median duration of seizures before treatment was 2 h; both were longer in rural patients than in urban patients (P < 0.05). The fatality rate on discharge was 15.9%. Logistic regression analysis showed the duration of CSE [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03-1.07], a history of epilepsy (OR 0.35, 95% CI 0.14-0.89), and respiratory depression (OR 5.96, 95% CI 2.49-14.24) were independent predictors of CSE prognosis. Central nervous system infection and AEDs withdrawal in epilepsy patients were the most important causes of CSE. There is a large gap between antiepileptic therapy in China and European Status Epilepticus guidelines.

Treatment of convulsive status epilepticus in infants and young children in Japan

We review the types and causes of convulsive status epilepticus (CSE) in infants and young children in Japan, and discuss the current recommendations for the use of intravenous (IV) drugs in managing this condition, and report on our clinical experiences. There are prolonged or continuous CSE and clustered or intermittent CSE, and treatments are different between them. In Japan, fosphenytoin and IV preparation of lorazepam and phenobarbital are not available. Recently, midazolam and lidocaine (LDC) have been widely used, although neither of these drugs have official approval for the management of CSE. Febrile seizures and epilepsies are common causes of CSE in infants and young children in Japan, followed by benign infantile convulsions (BIC), convulsions with gastroenteritis (CwG), and acute encephalitis with refractory CSE and intractable epilepsy (AECSEE), which are familiar disorders in Japan. BIC and CwG frequently present with clustered CSE and do not respond to IV diazepam, but have an excellent response with oral carbamazepine or IV LDC. CSE in AECSEE requires control with barbiturate coma. The Research Committee on Clinical Evidence of Medical Treatment for Status Epilepticus in Childhood has developed a proposed guideline for the treatment of CSE in childhood in Japan by an evidence-based approach and consensus conference. Initial management of seizures should be attempted mainly with IV diazepam, the second-line treatment involves IV midazolam followed by IV phenytoin if seizures persist, and the third-line treatment requires barbiturate coma. However, our experience of 247 episodes of CSE in 77 patients, predominantly with chronic epilepsy, required different second-line treatments for prolonged CSE compared with clustered CSE: the former were treated with IV midazolam or pentobarbital, and the latter were given IV phenytoin or LDC. We propose modifications to the guideline for CSE that the second-line treatment is divided by prolonged CSE and clustered CSE, and that the procedures for brain protection and systemic management are added.

Meningitis is a common cause of convulsive status epilepticus with fever

Aims: In children with convulsive status epilepticus (CSE) with fever, to determine the likelihood of acute bacterial meningitis (ABM), the proportion that are treated with antibiotics, and the proportion that...