Abstracts

Rationale: Status Epilepticus is a life-threatening medical emergency which requires early recognition and aggressive treatment. In this study, we examined the clinical features of children presenting with Status Epilepticus (SE) in a single tertiary care center. Methods: Retrospective chart review was performed for all children (age: 0-18 years) diagnosed with SE at Texas Children s Hospital (2002-2010) that were included in the neurology database. The clinical and demographic features, diagnostic tests utilized, and treatment responses were analyzed. Results: A total of 313 children were identified; 34 charts were unavailable for review. In the remaining 279 children [M/F: 162 (58%)/117 (42%)], mean age was 3.9 /-4.0 (range: 0-17 years). Febrile SE (FSE) occurred in 106 (38%); acute symptomatic etiology occurred in 71 (25%), and remote symptomatic in 102 (37%). Acute symptomatic etiology included CNS infection in 7%, trauma in 3%, metabolic (3%), genetic-inborn errors (9%), and hypoxia/ischemia in 16%. Non-convulsive SE (NCSE) occurred in 12 (4.3%) and newborn SE in 6 (2.2%). Duration of prolonged seizures ranged between 8 to 180 minutes (mean: 38.1-31.7). SE was longer than 60 minutes [refractory SE (RSE)] in 21 (7.5%) despite the administration of more than 2 conventional (first-line) antiepileptic drugs (AEDs). Repetitive seizures without a return to baseline mental status occurred in 91 (32.6%). Focal clinical features were reported by care givers or health professionals in 51 (18.3%). Fever was present at the time or within 24 hours prior to presentation in 133 (47.7%). A prior history of a febrile seizure occurred in 43 (15.4%), epilepsy in 78 (27.9%) and pre-existing neurological problems in 102 (35%). Recurrent SE developed in 46 (16.5%). EEG was obtained in 187 (67%); of these, continuous EEG-video (CEEG) monitoring was performed in 36 (12.9%). For first line AEDs, diazepam was administered in 49 (17.6%), lorazepam in 156 (55.9%), fosphenytoin in 147 (52.7%) and phenobarbital in 74 (26.5%). For fourth line AEDs, a single or continuous midazolam dose was required in 27 (9.7%) and pentobarbital in 13 (4.7%). Fourth-line AEDs were therefore needed in 40 (14.3%). The mortality rate was 3.5% (10/279) overall and 23% in RSE (5/21). Conclusions: Our clinical experience with status epilepticus from a single tertiary care center is consistent with previous studies of SE in children. We found that 1/3 of the children with SE had repetitive brief seizures and fourth-line AEDs were needed in 14.3% of children treated for SE.