Convulsive Status Epilepticus In Children Research Articles

Seizure control via pH manipulation: a phase II double-blind randomised controlled trial of inhaled carbogen as adjunctive treatment of paediatric convulsive status epilepticus (Carbogen for Status Epilepticus in Children Trial (CRESCENT))

BackgroundPaediatric convulsive status epilepticus is the most common neurological emergency presenting to emergency departments. Risks of resultant neurological morbidity and mortality increase with seizure duration. If the seizure fails to stop within defined time-windows, standard care follows an algorithm of stepwise escalation to more intensive treatments, ultimately resorting to induction of general anaesthesia and ventilation. Additionally, ventilatory support may also be required to treat respiratory depression, a common unwanted effect of treatment. There is strong pre-clinical evidence that pH (acid–base balance) is an important determinant of seizure commencement and cessation, with seizures tending to start under alkaline conditions and terminate under acidic conditions. These mechanisms may be particularly important in febrile status epilepticus: prolonged fever-related seizures which predominantly affect very young children. This trial will assess whether imposition of mild respiratory acidosis by manipulation of inhaled medical gas improves response rates to first-line medical treatment.MethodsA double-blind, placebo-controlled trial of pH manipulation as an adjunct to standard medical treatment of convulsive status epilepticus in children. The control arm receives standard medical management whilst inhaling 100% oxygen; the active arm receives standard medical management whilst inhaling a commercially available mixture of 95% oxygen, 5% carbon dioxide known as ‘carbogen’.Due to the urgent need to treat the seizure, deferred consent is used.The primary outcome is success of first-line treatment in seizure cessation. Planned subgroup analyses will be undertaken for febrile and non-febrile seizures. Secondary outcomes include rates of induction of general anaesthesia, admission to intensive care, adverse events, and 30-day mortality.DiscussionIf safe and effective 95% oxygen, 5% carbon dioxide may be an important adjunct in the management of convulsive status epilepticus with potential for pre-hospital use by paramedics, families, and school staff.Trial registrationEudraCT: 2021-005367-49. CTA: 17136/0300/001. ISRCTN: 52731862. Registered on July 2022.

Clinical profile, etiological factors and outcome of children with status epilepticus admitted in tertiary hospital: a prospective study

Background: Status epilepticus (SE) is a medical emergency, and its neurological outcome is a concern to every pediatrician in developing countries. The incidence of convulsive SE in children is approximately 10–27/100,000 per year, with the highest incidence in children less than one year of age. Approximately 30% of patients presenting with status epilepticus are having their first seizure. The objective of the study is to evaluate the clinical and etiological pattern of SE and its outcome in children admitted to PICU. Methods: This was a prospective study conducted among 50 patients aged 1 month to 12 years presenting with status epilepticus. The study was conducted over a period of one year from April 2022 to April 2023. Results: A majority of the patients were in the age group of 1-5 years (64%) and higher incidence of male children was observed (74%). Generalized tonic clonic seizure (GTCS) was predominant in 76% of the children and seizure duration was 10-20 minutes in 44% of the children. The most common etiologies were Meningoencephalitis (44%) and febrile seizures (20%). Nearly 70% of the children showed complete recovery with no neurological symptoms and 5 (10%) children died. Conclusions: Status epilepticus is a life-threatening emergency and timely management is essential to prevent morbidity and mortality. CNS infection is a major etiology and majority of the children showed good response with AED treatment.

The etiologies and outcome of convulsive status epilepticus in children at tertiary care hospital Kashmir India

Background: Convulsive status epilepticus (CSE) is a common neurological emergency, where immediate supportive and specific treatment determines the outcome of the patient. Therefore, immediate management and etiological workup of CSE should be done in tandem to decrease associated morbidity and mortality. Aims and Objectives: The study aimed to ascertain different etiologies and outcomes of CSE in children. Materials and Methods: The study was a prospective observational hospital-based study conducted in a tertiary care hospital from October 2020 to September 2022. Results: The most common type of seizure in CSE was GTCS, 154 cases (83.7%), followed by focal seizure 12 % (26 cases). Almost 35% of patients had CSE as a first presentation for PICU admission and the rest 65% of patients did have a previous history of seizures. The most common etiology of CSE was remote symptomatic, seen in 27.2%, followed by acute central nervous system infection in 19.5%, febrile status in 19.5%, and cryptogenic/idiopathic SD in 14.9%. Among the patients who had encephalitis, the common etiologies were enteroviruses and herpes simplex. We did not find any case of Japanese encephalitis, West Nile encephalitis, cerebral malaria, or dengue case in our study. Therefore, recommending cerebrospinal fluid panels for these vectors borne viral brain diseases is a waste of resources in Kashmir, India. Furthermore, we did not find any case of neurocysticercosis in our study as a cause of CSE. Conclusion: In our study, we had 16 cases of encephalitis, and most of them were caused by enteroviruses and herpes simplex virus. We did not find any case of Japanese encephalitis, West Nile encephalitis, cerebral malaria, or dengue case in our study. Vector-borne diseases transmitted by different mosquitoes do not occur in Kashmir.

Treatment of pediatric convulsive status epilepticus.

Status epilepticus is one of the most common life-threatening neurological emergencies in childhood with the highest incidence in the first 5 years of life and high mortality and morbidity rates. Although it is known that a delayed treatment and a prolonged seizure can cause permanent brain damage, there is evidence that current treatments may be delayed and the medication doses administered are insufficient. Here, we summarize current knowledge on treatment of convulsive status epilepticus in childhood and propose a treatment algorithm. We performed a structured literature search via PubMed and ClinicalTrails.org and identified 35 prospective and retrospective studies on children <18 years comparing two and more treatment options for status epilepticus. The studies were divided into the commonly used treatment phases. As a first-line treatment, benzodiazepines buccal/rectal/intramuscular/intravenous are recommended. For status epilepticus treated with benzodiazepine refractory, no superiority of fosphenytoin, levetirazetam, or phenobarbital was identified. There is limited data on third-line treatments for refractory status epilepticus lasting >30 min. Our proposed treatment algorithm, especially for children with SE, is for in and out-of-hospital onset aids to promote the establishment and distribution of guidelines to address the treatment delay aggressively and to reduce putative permanent neuronal damage. Further studies are needed to evaluate if these algorithms decrease long-term damage and how to treat refractory status epilepticus lasting >30 min.

CLINICAL SPECTRUM ANDETIOLOGY OF CHILDHOOD STATUS EPILEPTICUS IN A TEACHING HOSPITAL, KASHMIR, INDIA

Objective: The study aimed to ascertain clinicalspectrum and different etiologies of convulsive status epilepticus in children. Methods: Hospital based prospective observational study performed in department of Pediatrics in Children Hospital Government Medical College Srinagar Kashmir India from October 2020 to September 2022.Data were recorded with the help of a pre-formed proforma. Results: In this study, 184 cases of status epilepticus were included. The infants (less than 1-year)accountfor 23.9% ofthetotalcases(n=184) and67.4% children were in the age group &lt; 5 years. The total number of cases in the age group &gt;10yrs was only 6.5%.Outof184children,malechildrenwere102(55.4%)andfemalechildrenwere82(44.6%).We found that 81.5%ofthecases of CSE reachedEmergency Room (ER)within30-60minutes after seizure initiation and18.5%reachedafter 60 minutes. Themostcommonetiologyassociatedwithstatusepilepticuswasremotecauses like post HIE or cerebral palsy, seen in 25.54% cases, followed by acute CNS infection in 18.45 cases (pyogenic meningitis 10.3%, viral encephalitis 4.9%, and tubercular meningitis 3.26%). Conclusion: The outcome was better for patients who had less seizure duration and received early effective standard treatment protocol within a given time frame. The patients who had prolonged seizures or first treatment hadapoor outcome. Our study reveals that though we have successfully decreased the infant mortality rate, still there is large scope for decreasing morbidity by improving the neonatal care services across Kashmir and the intact Neonate intact Nation should be our mission and passion. Furthermore, it seems very imperative that all patients of CSE should receive early effective standard treatment at doorsteps to decrease the associated morbidity and mortality.

Efficacy and Safety Comparison Between Lorazepam and Diazepam in Treating Convulsive Status Epilepticus in Children: An Evidence-Based Case Report

Introduction: Indonesia still recommends diazepam for epilepsy, but the International League Against Epilepsy increasingly favours lorazepam. Some reports indicate diazepam being less effective and causing side effects. This report presents a difficult-to-treat convulsive status epilepticus (CSE) case in a 10-month infant who received diazepam, questioning if intravenous/rectal lorazepam is a better initial therapy than diazepam for hospitalized children with CSE. Methods: Following the patient-intervention-comparison-outcome (PICO) formula, we searched for evidence in four journal databases (Pubmed, Proquest, EBSCOHost, and Cochrane). Studies meeting inclusion and exclusion criteria were appraised. Results: Through three systematic reviews and meta-analyses, our clinical query was addressed. One study revealed that rectal lorazepam was more effective in stopping seizures than rectal diazepam (RR 2.86). Meanwhile, two studies found that intravenous lorazepam exhibited similar efficacy in seizure cessation compared to intravenous diazepam (RR 1.04 and OR 1.03, respectively). Both drugs showed no significant difference in the time required to stop seizures or the necessity for additional doses or adjunctive medications to achieve such cessation, nor in the likelihood of refractory seizure within 24 hours. Two studies indicated that intravenous lorazepam had a reduced risk of respiratory depression (RR 0.71 and OR 0.62, respectively). Regardless of the administration route, lorazepam was linked to a lower probability of ICU admission (RR 0.15) than diazepam. Conclusion: Intravenous lorazepam and diazepam are equally effective for treating CSE, but rectal lorazepam is considered better at stopping seizures and preventing their recurrence compared to diazepam. Furthermore, lorazepam is deemed safer, especially when given intravenously.

Ketamine as advanced second-line treatment in benzodiazepine-refractory convulsive status epilepticus in children.

Status epilepticus (SE) is one of the most common neurological emergencies in children. To date, there is no definitive evidence to guide treatment of SE refractory to benzodiazepines. The main objectives of treatment protocols are to expedite therapeutic decisions and to use fast- and short-acting medications without significant adverse effects. Protocols differ among institutions, and most frequently valproate, phenytoin, and levetiracetam are used as second-line treatment. After failure of first- and second-line medications, admission to the intensive care unit and continuous infusion of anesthetics are usually indicated. Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that has been safely used for the treatment of refractory SE in adults and children. In animal models of SE, ketamine demonstrated antiepileptic and neuroprotective properties and synergistic effects with other antiseizure medications. We reviewed the literature to demonstrate the potential role of ketamine as an advanced second-line agent in the treatment of SE. Pharmacological targets, pathophysiology of SE, and the receptor trafficking hypothesis are reviewed and presented. The pharmacology of ketamine is outlined with related properties, advantages, and side effects. We summarize the most recent and relevant publications on experimental and clinical studies on ketamine in SE. Key expert opinion is also reported. Considering the current knowledge on SE pathophysiology, early sequential polytherapy should include ketamine for its wide range of positive assets. Future research and clinical trials on SE pharmacotherapy should focus on the role of ketamine as second-line medication.

儿童惊厥性癫痫持续状态的研究进展

儿童惊厥性癫痫持续状态的研究进展

Comparison of levetiracetam as second-line drug with fosphenytoin in convulsive status epilepticus among children: A single center, open-label randomized controlled trial

Background: Status epilepticus (SE) is the most common neurologic emergency in the pediatric age group often serious and life-threatening. Although newer drugs were used, morbidity and mortality are still high. This study was done to compare the efficacy of levetiracetam with the existing second-line drug fosphenytoin in the treatment of SE.Subjects and Methods: This was a prospective, randomized parallel group trial from Pediatric Intensive Care Unit of a Tertiary Care Institute. One hundred children were recruited according to the inclusion and exclusion criteria, 50 in fosphenytoin group and 50 in levetiracetam group. Two groups were compared with respect to clinical cessation of seizures, recurrence, adverse event, and outcome.Results: Male-to-female ratio was 1.45:1. Seizure were controlled in 37 (74%) in fosphenytoin group and 28 (56%) in levetiracetam group) (P = 0.059). The mean time for cessation of seizures was 11.16 ± 3.58 min in fosphenytoin group as compared to was 12.78 ± 3.07 min in levetiracetam group (P = 0.059) The seizure recurrence in first 24 h (18 [36%] vs. 12 [24%]) (P = 0.643) and development of shock (14 [28%] vs. 11 [22%]) (P = 0.488) was comparable in two groups. Overall mortality was 10 (20%) in fosphenytoin group as compared to 7 (14%) levetiracetam group (P = 0.281).Conclusions: Efficacy of intravenous levetiracetam is comparable to fosphenytoin as a second-line medication in the management of convulsive SE in children.

Current Management of Generalized Convulsive Status Epilepticus in Children.

Generalized convulsive status epilepticus (GCSE) in pediatric patients is an emergency condition with high morbidity and mortality and potentially irreversible brain damage, leading to cognitive deterioration, psychomotor retardation, chronic epilepsy with recurring seizures, and other complications. Treatment must be initiated in the impending GCSE phase, within five minutes of the onset of a generalized convulsive seizure. Early initiation of treatment and adequate therapy is a prerequisite for a good patient outcome.

Disability and Mortality in Convulsive Status Epilepticus in Children at 3 Months' Follow-Up: A Prospective Study from India.

Background Convulsive status epilepticus (CSE) is a common neurological emergency with high mortality, morbidity, and poor quality of life. There is a paucity of follow-up studies from developing nations in pediatric age group. Objectives This article looks for clinico-etiological profile of CSE and estimates the immediate and short-term mortality in children with CSE and its predictive factors. Methodology This prospective longitudinal study was done at a tertiary care institute of Northern India. The patients between the ages of 1 and 16 years with CSE were enrolled after informed consent, they were observed in the hospital, and survived patients were followed till 3 months after discharge. Results A total of 200 patients (58% males) were enrolled. Acute symptomatic (63.5%) was the most common etiology. Twenty-five (12.5%) patients died during hospital stay; at discharge, 160 (80%) had good recovery and rest had a varying range of disability. The predictive factors for poor outcome were female gender, duration of CSE > 1 hour at presentation, generalized seizures, Glasgow Coma Scale < 8 at presentation, refractory status epilepticus, need for critical care support, and acute symptomatic etiology. On follow-up, two patients died at 1-month and one at 3-month follow-up, the cause of death was probably seizures in two patients and feed aspiration in one patient. Seven patients deteriorated from good recovery scoring to moderate disability during the time interval between first and second follow-up, none of them reported apparent repeat seizures. Conclusion Pediatric CSE is associated with immediate poor outcome; risk of death and new disabilities persist after discharge thus proper follow-up is essential.

Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

Background: Optimal care of Convulsive status epilepticus (CSE) can be related to multiple barriers in resource-limited countries.&#x0D; Objectives and methods: Since limited data of CSE management are available from South-East Africa, we performed a retrospective analysis of the electronic records of pediatric patients with CSE admitted to the Maputo Central hospital from January 2016 until April 2019.&#x0D; Results: Our database consisted out of 39 patients. The average age was 5.15 (range 0.3-13.8) years and demographic characteristics did not show a relation to CSE characteristics or outcomes. However, the total stay in the hospital was negatively correlated with age (p=0.0314). Moreover, 14 patients needed to be admitted to the IC, which was correlated to having generalized motor seizures (p=0.0253), and a relatively higher need for a second AED to control their CSE (p=0.0131). Regarding AED use, the first AED was a IV benzodiazepine (BZD: midazolam (MIDA) or diazepam (DIAZ)) or IV phenytoin (PHEN) when BZDs were not available. There was no statistically significant difference between the efficacy of MIDA vs. DIAZ. Eleven patients received PHEN as a second-line drug, of which only two patients needed an additional dose of PHEN. None of the patients died and five patients (13.2%) had an extra comorbidity after CSE.&#x0D; Conclusions: Although limited AEDs were available in our study, compared to more AEDs in other developing and developed countries, we report the successful cessation of CSE in the majority of cases. We recommend strategies to improve prehospital management such as the use of non-IV BZD use, to limit the need for patients to be admitted to the IC and thereby potentially decreasing the number of AEDs, morbidity and hospital duration. Moreover, our data underline the conversion to second-line AEDs (PHEN) to be adequate in nearly all patients.

Long-term prognosis and predictors of outcomes after childhood convulsive status epilepticus

Objective:Childhood convulsive status epilepticus (CSE) is widely known to be associated with short-term and long-term mortality and morbidity, but the role of CSE itself on adverse outcomes is debatable. The additional effect of CSE characteristics on outcomes after CSE and whether prolonged seizures cause any long-term hippocampal injury which leads to developmental or memory impairment is uncertain. This review provides an overview of long-term prognosis after childhood CSE, highlighting data from recent literature.Findings:In previously normal children, the long-term prognosis after childhood CSE is favorable, with low incidence of epilepsy, motor, and cognitive difficulties. Mesial temporal sclerosis is uncommon in children after prolonged febrile seizures. In children with symptomatic causes and those with pre-existing neurological abnormalities, there is substantial morbidity after childhood CSE. Etiology is the primary determinant of outcome after childhood CSE and the additional effect of CSE characteristics such as seizure duration seems to be less than previously believed.

Efficacy and Safety of Levetiracetam vs. Phenytoin as Second Line Antiseizure Medication for Pediatric Convulsive Status Epilepticus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To evaluate the efficacy and safety of levetiracetam (LEV) in comparison to phenytoin (PHT) as second line antiseizure medication (ASM) for Pediatric convulsive status epilepticus (SE). PubMed, Embase, Google scholar/Google, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) assessing LEV and PHT as second line agent for convulsive SE in children <18 years published between 1 January 2000 and 30 November 2020. The data were pooled regarding the proportion of children achieving seizure cessation within 5-60 min of completion of study drug infusion (primary outcome); and seizure cessation within 5 min, time to achieve seizure cessation, seizure recurrence between 1 to 24 h, intubation and cardiovascular instability (secondary outcomes). Data were analyzed using RevMan version 5.4 and quality analysis was done using Cochrane risk-of-bias tool. The study protocol was registered with PROSPERO. Twelve RCTs with 2293 children were included. Seizure cessation within 5-60 min was similar with both the drugs [82% in LEV vs. 77.5% in PHT, risk ratio (RR) = 1.04, 95% confidence interval (95% CI) 0.97-1.11, p = 0.30]. Seizure recurrences within 1-24 h was higher with PHT in comparison to LEV (16.6% vs. 9.7%, RR = 0.63, 95% CI 0.44-0.90, p = 0.01). Higher proportion of children in PHT group required intubation and mechanical ventilation (21.4% vs. 14.2%, RR = 0.54, 95% CI 0.30-0.98, p = 0.04). Seizure cessation within 5 min, time to achieve seizure cessation, and cardiovascular instability were similar with both the drugs. Three RCTs were at low risk of bias and nine were at high risk of bias. The efficacy of LEV is similar to PHT as second line ASM for Pediatric convulsive SE. Seizure recurrences between 1 to24 h and requirement of intubation and mechanical ventilation were significantly higher with PHT in comparison to LEV.

Efficacy and safety of levetiracetam versus phenytoin as second-line drugs for the treatment of children with convulsive status epilepticus: a Meta analysis

Objective To systematically evaluate the efficacy and safety of levetiracetam (LEV) versus phenytoin (PHT) as second-line drugs for the treatment of convulsive status epilepticus (CSE) in children. Methods English and Chinese electronic databases were searched for the randomized controlled trials comparing the efficacy and safety of LEV and PHT as second-line drugs for the treatment of childhood CSE. RevMan 5.3 software was used for data analysis. Results Seven studies with 1 434 children were included. The Meta analysis showed that compared with the PHT group, the LEV group achieved a significantly higher control rate of CSE (RR=1.12, 95%CI:1.00-1.24, P=0.05), but there was no significant difference between the two groups in the recurrence rate of epilepsy within 24 hours (RR=0.82, 95%CI:0.22-3.11, P=0.77) and the rate of further antiepileptic drug therapy (RR=0.97, 95%CI:0.64-1.45, P=0.87). There was no significant difference in the incidence rate of adverse events between the two groups (RR=0.77, 95%CI:0.55-1.09, P=0.15). Conclusions LEV has a better clinical effect than PHT in the treatment of children with CSE and does not increase the incidence rate of adverse events.

Convulsive status epilepticus in children recently diagnosed with epilepsy and long-term health-related quality of life

PurposeThe objective of this study was to delineate the long-term impact of pediatric convulsive status epilepticus (CSE) on health-related quality of life (HRQOL) in children recently diagnosed with epilepsy. MethodsChildren with newly-diagnosed epilepsy were recruited between 2004–2007 through a Canada-wide population-based study, the Health-Related Quality of Life Study in Children with Epilepsy Study (HERQULES). Eligible children were 4–12 years of age at epilepsy diagnosis; consequently, children with the more catastrophic syndromes and epileptic encephalopathies typically diagnosed at younger ages were ineligible. Participants were followed over 10 years, and neurologists identified those with CSE in the first two years after epilepsy diagnosis. HRQOL was self-reported by adolescents and young adults (AYAs) in the long-term, and reported by parents at multiple time points throughout the 10-year follow-up. ResultsA total of 204 AYAs were followed over the long-term, 12 of whom had a history of CSE. Parents of those with CSE reported poorer HRQOL in their children two years after the epilepsy diagnosis, (Cohen’s d = 0.58, p = .037), though not at the 10-year follow-up (d = 0.28, p = .19). Results from AYAs’ self-reports at the 10-year follow-up were similar, such that mean HRQOL scores were poorer for AYAs with CSE, though this difference was not significant (d = 0.39, p = .11). Results were similar when adjusting for HRQOL at the time of epilepsy diagnosis. ConclusionThese findings suggest that compromised HRQOL in the short-term after CSE may resolve over the long-term. It will be important for future studies to focus on patient-reported outcomes in reporting the long-term sequelae of CSE.

Long-term outcomes after childhood convulsive status epilepticus.

It is widely accepted that childhood convulsive status epilepticus (CSE) has associated short-term and long-term mortality and morbidity. However, the role of CSE itself on subsequent adverse outcomes is still debated. In addition, whether prolonged seizures cause any long-term hippocampal injury and developmental or memory impairment is uncertain. In this review, we aim to provide an overview of long-term outcomes after childhood CSE, highlighting data from recent literature on this subject. Long-term outcome after childhood CSE is favorable in previously normal children, with low incidence of epilepsy, motor and intellectual disability, behavioral impairment and need for special educational provision. Mesial temporal sclerosis is uncommon in children after prolonged febrile seizures. There is substantial morbidity after childhood CSE, but this is seen primarily in children with symptomatic causes and preexisting neurological abnormalities. Cause is the primary determinant of outcomes after childhood CSE and the additional effect of CSE characteristics such as seizure duration seems to be less than previously believed. Childhood CSE is associated with substantial neurological, cognitive and behavioral morbidity. Early identification of these difficulties and appropriate intervention are likely to have a major positive impact on their quality of life.

Is it a Tie at This Point in the Game? Efficacy of Levetiracetam and Phenytoin for the Second-Line Treatment of Convulsive Status Epilepticus.

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Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial

Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial

Factors influencing control of convulsive status epilepticus in children

Background: Convulsive status epilepticus (CSE) is an important cause of morbidity and mortality in pediatrics. Objectives: The objectives of the study were to examine the influence of any clinical factor on control of CSE in children. Methods: Cases of CSE in the age group of 1 month–12 years, admitted to the emergency ward of a tertiary care hospital, over a period of 1 year, were studied, prospectively. Only those cases that were actively convulsing at arrival were enrolled. Difficult cases were shifted pediatric intensive care unit and were put on mechanical ventilator as needed. After initial stabilization, detailed case-work up and appropriate investigations to find the etiology were done. The data were analyzed statistically and p&lt;0.05 was considered as statistically significant. Results: The data of 50 cases that fulfilled the enrolment criteria were analyzed. Convulsions in the majority of the cases could be controlled within 30 min. Out of the study patients, 39 cases (78%) needed &gt;1 drug for controlling the convulsive episodes. Control was extremely difficult in 10 (20%) of the cases while 3 (6%) cases died. The time needed to control the episodes showed significant correlation with several clinical factors, namely focal seizure with impaired consciousness, multiple episodes of convulsion (discrete type), focal deficit, Glasgow Coma Scale score &lt;9, abnormal neuroimaging finding, central nervous system infections (meningitis and encephalitis together), and prolonged duration of convulsions before arrival at the emergency ward. However, on multivariate analysis prolonged duration of convulsion before arrival at emergency was found to be the most significant predictor of time needed to control the episodes. Conclusion: Prolonged duration of convulsion before arriving at the hospital can be considered to be a predictor of difficult control of CSE in children.