Sustained Refractory Status Epilepticus in Children.
Abstract number :
2.192
Submission category :
Year :
2001
Submission ID :
1203
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
E.J. Donner, MD, Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; D. Garros, MD, Pediatric Intensive Care Unit, Stollery Childrens Health Center, Univ. of Alberta, Edmonton, AB, Canada; O.C. Snead, III, MD, Di
RATIONALE: Status epilepticus (SE) is a life threatening neurologic emergency characterized by prolonged seizures. When seizures fail to respond to first line treatments, the condition may be termed refractory status epilepticus. Among children with refractory status epilepticus, some have seizures which persist beyond 24 hours. These children may have either clinical or electrographic evidence of continuing seizures. We have termed this condition Sustained Refractory Status Epilepticus (SRSE). The objective of this study was to examine the treatment, etiology and outcome of SRSE in children with no previous medical or neurologic condition predisposing to SE.
METHODS: All cases of SE admitted to the Critical Care Unit of the Hospital for Sick Children, Toronto, Canada from June 1994 to December 1999 were reviewed. Cases of SRSE in children with no ongoing medical or neurological condition predisposing to seizures were critically reviewed for details of history, treatment and etiology of SE. Outcomes at ICU discharge were rated on the Pediatric Cerebral Performance Category Scale.
RESULTS: Seven cases of SRSE in previously well children were identified. There were 4 boys and 3 girls aged 3.8 to 14.7 years. All children had infectious symptoms with fever preceding the onset of seizures. Time until initiation of drug coma ranged from 2 to 125 hours. The duration of status epilepticus ranged from 39 to 108 days, with a median of 49 days. The outcomes included death in 4 children and severe disability at time of ICU discharge in the remaining 3 children. Etiology of SE was determined in 5 children, 3 children had polymerase chain reaction confirmed viral encephalitis and 2 children had positive tissue diagnoses of post infectious demyelination syndromes. Extensive metabolic and rheumatologic investigations were negative in all children. In 2 children, the etiology of SRSE remains unknown.
CONCLUSIONS: We present a series of previously well children with SE lasting longer than 24 hours. The median duration of seizures was 49 days suggesting that SE which persists beyond 24 hours may identify a very prolonged course. At onset of seizures, children with SRSE are difficult to distinguish from uncomplicated SE. SRSE is most often associated with viral encephalitis or a post-infectious demyelinating syndrome and is not associated with a primary metabolic or rheumatologic disorder. The outcome of SRSE is uniformly poor. Early treatment of SE in this population may be suboptimal suggesting that earlier diagnosis and treatment of SE may improve outcomes.