Characteristics and Outcomes of Pediatric Patients with Prolonged Convulsive Status Epilepticus
Abstract number :
1.345
Submission category :
4. Clinical Epilepsy / 4D. Prognosis
Year :
2024
Submission ID :
1315
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jennifer Gettings, MD FRCPC – Boston Children's Hospital - Harvard Medical School
Krista Eschbach, MD – University of Colorado Anschutz Medical Campus – Children’s Hospital Colorado
Raquel Farias-Moeller, MD – Medical College of Wisconsin
William Gaillard, MD – Children's National Hospital
Tracy Glauser, MD – Comprehensive Epilepsy Center, Cincinnati Children’s Hospital
Joshua Goldstein, MD – Northwestern University
Howard Goodkin, MD, PhD – University of Virginia
Zachary Grinspan, MD, MS – Weill Cornell Medicine
Réjean Guerriero, DO – Washington University in St Louis
Babitha Haridas, MBBS – Johns Hopkins Medicine
Robert Kahoud, MD – Mayo Clinic
Tobias Loddenkemper, MD – Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Lindsey Morgan, MD – Seattle Childen's Hospital
Edward Novotny, MD – University of Washington School of Medicine
Adam Ostendorf, MD – Pediatrics, Division of Pediatric Neurology
Juan Piantino, MD – Oregon Health and Science University
Craig Press, MD – Children's Hospital of Philadelphia
Tristan Sands, MD, PhD – Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
Robert Tasker, MBBS, MD – Boston Children's Hospital
Agnieszka Kielian, MD – Boston Children's Hospital - Harvard Medical School
Kerri LaRovere, MD, MMSc – Boston Children's Hospital
Rationale: Status epilepticus (SE) is a life-threatening emergency with high rates of resultant morbidity and mortality. There are limited data in the literature on pediatric patients with responsive established status epilepticus (rESE), refractory status epilepticus (RSE), and super refractory status epilepticus (SRSE). The objective of this study is to describe characteristics and outcomes among pediatric patients with different seizure durations, including patients with rESE, RSE, and SRSE.
Methods: This is a retrospective cross-sectional study based on prospective data collected by the pediatric Status Epilepticus Research Group (pSERG), a consortium of 21 tertiary pediatric hospitals in the United States and Canada. Pediatric patients (aged 1 month to 21 years) with convulsive SE at onset who received at least two benzodiazepines (BZD) and one non-BZD anti-seizure medication (ASM) were included. We excluded patients with SE treated with BZD rescue medications only, non-convulsive SE at onset, or psychogenic non-epileptic events. Patients with missing data were excluded. Enrolled patients were divided into quartiles based on seizure duration in minutes (1st quartile, ≤70; 2nd quartile, 71-150; 3rd quartile, 151-480; 4th quartile >480). Seizure duration included the entire clinical and electrographic seizure duration. We stratified demographics, clinical factors, treatments, and outcomes by quartile of seizure duration.
Results: Of 718 patients (57% male, median age 4.4 years), median seizure duration was 150 minutes (1st quartile, ≤70; 2nd quartile, 71-150; 3rd quartile, 151-480; 4th quartile >480). Eighteen patients (2%) passed away prior to discharge. There was an association between longer SE duration quartile and absence of a prescription for rectal diazepam, death, new neurologic deficit at discharge, cardiac arrest, ventilation ≥7 days, and ICU duration ≥7 days.
Conclusions: A longer duration of SE is associated with lower survival and higher rates of adverse hospital outcomes. Absence of a prescription for rectal diazepam is associated with a longer seizure duration. Identification of clinical variables associated with a longer duration of pediatric status epilepticus may permit sooner identification of patients at risk. Identifying these risk factors may result in implementation of quality improvement measures and education to prevent and improve the treatment of pediatric convulsive status epilepticus.
Funding: American Epilepsy Society, Pediatric Epilepsy Research Fund, Epilepsy Foundation of America, Epilepsy Research Fund
Clinical Epilepsy