DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20190093

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

Madhu P. K., Krithika R.

Abstract


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.


Keywords


Children, Etiology, Outcome, Status epilepticus

Full Text:

PDF

References


Pellock JM. Status epilepticus in children: update and review. J Child Neurol. 1994;9(2):27-35.

Mikati MA, Hani AJ. Status epilepticus. In: Kliegman R, Behrman R, Nelson W. Nelson textbook of pediatrics, 20e; Elsevier; 2016:2854-2855.

Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus-Report of the ILAE Task Force on Classification of Status Epilepticus. Epilep. 2015;56(10):1515-23.

Mishra D, Sharma S, Sankhyan N, Konanki R, Kamate M, Kanhere S, et al. Consensus guidelines on management of childhood convulsive status epilepticus. Indian Pediatr. 2014;51(12):975-90.

Murthy JM, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epileps. 2007;48(12):2217-23.

Morton LD, Pellock JM. Status Epilepticus. In: Swaiman KF, Ashwal S, Ferriero DM, Nina F Schor NF. Swaiman’s Pediatric Neurology: Principles and Practice, 5e; Elsevier 2012.p.798-810.

Gulati S, Kalra V, Sridhar MR. Status epilepticus in Indian children in a tertiary care center. Indian J Pediatr. 2005;72(2):105-8.

Kumar M, Kumari R, Narain NP. Clinical Profile of Status epilepticus (SE) in Children in a Tertiary Care Hospital in Bihar. J Clin Diagn Res: JCDR. 2014;8(7):14-7.

Kumar MA, shrivastava K. Outcome and Determinants of Outcome of Status Epilepticus at Discharge in Indian Children. european journal of pharmaceutical and medical research. 2016,3(11): 498-501.

Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368(9531):222-9.

Bergamo S, Parata F, Nosadini M, Boniver C, Toldo I, Suppiej A, et al. Children with convulsive epileptic seizures presenting to Padua Pediatric emergency department: the first retrospective population-based descriptive study in an Italian Health District. J Child Neurol. 2015;30(3):289-95.

DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurol. 1996;46(4):1029-35.

Fernández IS, Klehm J, An S, Jillella D, Kapur K, Zelener J, Rotenberg A, Loddenkemper T. Comparison of risk factors for pediatric convulsive status epilepticus when defined as seizures≥ 5min versus seizures≥ 30min. Seiz. 2014;23(9):692-8.

Chin RF, Verhulst L, Neville BG, Peters MJ, Scott RC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psychiat. 2004;75(11):1584-8.

Sadarangani M, Seaton C, Scott JA, Ogutu B, Edwards T, Prins A, et al. Incidence and outcome of convulsive status epilepticus in Kenyan children: a cohort study. Lancet Neurol. 2008;7(2):145-50.

Das NK, Soren B, Gupta D. Clinical Profile, Aetiology, and Short-Term Outcome of Convulsive Status Epilepticus in Children in Eastern India.JMSCR.2017; 5(1):15914

Barzegar M, Mahdavi M, Galegolab Behbehani A, Tabrizi A. Refractory Convulsive Status Epilepticus in Children: Etiology, Associated Risk Factors and Outcome. Iran J Child Neurol. 2015;9(4):24-31.

Thandavarayan M, Ramaswamy S, Bose P, Thirumalaikumarasamy S. Immediate outcome and risk factors determining the outcome of status epilepticus in children attending tertiary care centre. Int J Contemp Pediat. 2017;4(4):1289-95

Kwong KL, Lee SL, Yung A, Wong VC. Status epilepticus in 37 Chinese children: aetiology and outcome. J Paediatr Child Health. 1995;31(5):395-8.

Kravljanac R, Jovic N, Djuric M, Jankovic B, Pekmezovic T. Outcome of status epilepticus in children treated in the intensive care unit: a study of 302 cases. Epilep. 2011;52(2):358-63.