Abstracts

Status epilepticus (SE) is characterized by continuous seizure activity and is a medical emergency. The purpose of this study was to prospectively characterize all cases of new onset seizures presenting as SE in a large population of children.
Over 27 months, all children presenting to our institution with a new onset seizure were prospectively evaluated as part of a clinical care pathway.
Of 473 children presenting with new onset seizures, 65 (14%) presented with SE (seizures lasting longer than 20 minutes). Twenty-two seized for over 60 minutes. Patient ages ranged from 0.2-15.6 years (mean 3.8 years, median 2.9 years). Multiple seizure types were noted at presentation including complex partial (48%), generalized (34%), focal with secondary generalization (15%), and simple partial (3%). The average age was 2.2 years for onset with generalized seizures, 5.1 years for focal seizures, and 4.2 years for focal seizures with generalization. Etiologies included idiopathic (32%), remote symptomatic (24%), illness related (26%), CNS infection (9%), electrolyte abnormalities (5%), trauma (3%), and hemorrhage (1%). None of the cases of SE were secondary to tumor or stroke. Twenty-eight patients (43%) had normal EEGs at presentation. Focal spikes or slowing were identified in 30 patients while 14 patients had generalized features on EEG. Two children had PLEDs. Head CTs was performed on all patients and were normal in 69%. Abnormal findings included non-specific changes, edema, trauma, cortical dysplasia, metabolic disease, periventricular leukomalacia and acute disseminated encephalomyelitis.
In conclusion, 14% of children had SE as an initial presentation of a new onset seizure. Complex partial SE was the most common seizure type at presentation. The average age of SE onset was at a relatively young average age of 3.8 years. Toddlers tended to present with generalized seizures while older children were more likely to present with focal seizures with or without generalization. A wide range of etiologies was identified with a third of cases idiopathic. Almost half of the population had a normal EEG at presentation but among abnormal EEGs, focal findings were most common. While the majority of patients had a normal head CT at presentation, diagnostically relevant abnormalities were identified in a minority of patients. These findings may be helpful in the diagnosis, work-up and management of children presenting with new-onset status epilepticus.