Abstracts

Rationale: We have previously shown that recovery time to full consciousness following epileptic seizures in children is dependent on aetiology (Allen et al,Recovery of consciousness following epileptic seizures in children. Arch Dis Child 2007; 92: 39-42). However, despite acute symptomatic epileptic seizures (ASS) being common in children with CNS infections, previous studies included very few such cases. We hypothesised that few children with ASS associated with central nervous system infections (ASS_inf) had been included in previous studies because their ictal and post-ictal courses differ from seizures of other aetiologies. Intubation prior to full recovery would have led to exclusion from previous studies. We sought to test this, to calculate the recovery time from ASS_inf in those not intubated and to compare this with those from seizures of other aetiologies. Methods: A casenote analysis of children aged 4 weeks to 16 years inclusive treated for CNS infections at our institution over 56 months was undertaken. Information on the type, duration, aetiology and timing of seizures during admission was collected. The timing and reason for intubation were recorded. In those with ASS not intubated, coma scores were used to determine recovery time to full consciousness. Intubation rates and recovery times were compared to those from our previous studies which had used the same methodology (Allen et al). Results: 81 children with CNS infections were identified (47 male; median age 12 months, range 1 month - 15.5 years). Their diagnoses were: bacterial meningitis (44), aseptic meningitis (11), focal CNS infection (15), encephalitis (10) and post-operative infection (1). 40 had had one or more ASS_inf. 22 had an episode of status epilepticus (SE). The intubation rate was higher in children with ASS_inf than in children with a CNS infection who did not have an ASS (52.5% v 22%) (p=0.006). The intubation rate in children with ASS_inf was higher than that for seizures of other aetiologies (52.5% v 3.23%) (p<0.0001). The intubation rate in children with bacterial meningitis (BM) was higher than that for seizures of other aetiologies (65% v 3.23%) (p<0.001). The median recovery time following an ASS_inf was 4.33 hours (range 0-207 hours). Patients with ASS_inf took 4.3 times longer to recover than patients with seizures from all causes (p<0.001), 3.0 times longer than patients with remote symptomatic seizures (p=0.004) and 8.8 times longer than patients with febrile seizures (p<0.001). In patients with BM recovery times were respectively 6.3 (p<0.001), 3.4 (p=0.029) and 8.3 (p=0.001) times longer. Conclusions: Seizures in children with CNS infections are often longer, more likely to be associated with SE, more likely to require intubation and take longer to recover from than seizures of other aetiologies, including febrile seizures. Recognition of this may help in the early diagnosis of CNS infection in children who present with seizures.