Abstracts

Rationale: Patients with Refractory Status Epilepticus (RSE) present high morbidity and mortality. Few pediatric series have been reported. We analyze the epidemiological, clinical, and electroencephalograpic features in pediatric patients with RSE. Methods: Retrospective study including patients under 15 years of age, admitted to Catholic University Hospital between November 2005 and May 2010, who underwent continuous electroencephalograpic monitoring (cEEG). Patients were identified from the EEG laboratory records. RSE was defined as any clinical or electrical seizure (or both) lasting for more than 60 minutes and persisting after receiving first and second line antiepileptic drug (AEDs) treatment. Four line of treatments were defined: (1) benzodiazepines, (2) phenytoin, valproate and/or phenobarbital, (3) midazolam, propofol or thiopental infusion, (4) any other drug or ketogenic diet. Patient clinical information was collected by chart review and included age, sex, preexisting medical and neurological conditions, seizure history, types of anticonvulsants used, neuroimaging findings and outcome at the time of discharge from hospital. Results: We identified 13 patients with RSE, 12 male, mean age of 49,6 months upon admission (range 1,5-156 months). 7 had prior diagnosis of epilepsy and were taking a mean of 4 AEDs. Brain magnetic resonance was normal in 6/13 on admission. In 2, the initial EEG showed electrical seizures, in 4 interictal discharges and 4 had diffuse slowing. After initiation of cEEG, 9 presented convulsive status epilepticus (SE) and 4 Nonconvulsive status epilepticus (NCSE). cEEG showed that five patients with SE evolved into NCSE. Subsequently, therapy was modified in 10 patients. 5 patients had an acute symptomatic cause, 4 had remote ethiologies, 3 progressive diseases and 1 was associated to fever. Regarding treatment, one patient responded to second line treatment, three to third line, seven to fourth line, one persisted on status and one died. RSE remited on average at 9,6 days (1-47) and cEEG extended for a mean of 12,4 days (3-49). Most frequent complications associated to treatment of SE and NCSE were respiratory depression and hemodynamic inestability. One patient had Propofol infusion syndrome. At discharge, 8 patients had difficult to treat epilepsy and neurological deficit, 3 had epilepsy, one returned to baseline and one died. All epileptic patients were receiving at least 3 AEDs. Conclusions: The majority of our patients evolved with difficult to treat epilepsy and neurological deficits, confirming the high impact of this condition on the neurological development of affected children. There was a high incidence of NCSE after SE (55,5%). Although this is a small series, these findings coincide with previous reports. Although 10/13 initial EEG were abnormal, cEEG was more useful in the monitoring and treatment of these patients. This technique is scarcelly availaible in our country and its use should be encouraged to improve management of SE.