[S29.005] Etiology of Pediatric Refractory Convulsive Status Epilepticus. Results from the Pediatric Status Epilepticus Research Group (pSERG)
William Gaillard,1Howard Goodkin,2Nicholas Abend,3Satish Agadi,4Ravindra Arya,5Rajit Basu,6Jessica Carpenter,1Kevin Chapman,7Nathan Dean,1Tracy Glauser,6Michele Jackson,8Mohamad Mikati,9Katrina Peariso,6Geetanjali Rathore,4Ivan Sanchez Fernandez,8Robert C. Tasker,8Alexis Topjian,3David A. Turner,9Angus Wilfong,4Korwyn Williams,10Tobias Loddenkemper8
1Washington, DC, USA, 2Charlottesville, VA, USA, 3Philadelphia, PA, USA, 4Houston, TX, USA, 5USA, 6Cincinnati, OH, USA, 7Aurora, CO, USA, 8Boston, MA, USA, 9Durham, NC, USA, 10Phoenix, AZ, USA
OBJECTIVE: To describe the etiologies of refractory convulsive status epilepticus in children.
BACKGROUND: There are limited data on the causative and contributory conditions in children with refractory convulsive status epilepticus.
DESIGN/METHODS: This prospective multicenter cohort study characterizes the pre-existing conditions and acute seizure cause of refractory convulsive status epilepticus. Inclusion criteria: 1) admitted between June 2011 and September 2013, 2) age from 1 month to 21 years, 3) convulsive seizures at onset, and 4) failure of ≥ 2 AEDs to terminate seizures or the initiation of a continuous infusion of medications for seizure control. Exclusion criteria: Non-convulsive status epilepticus.
RESULTS: 105 cases in 105 patients (54 males) with a mean (SD) of 5.6 (±5.3) years were enrolled in the study. Sixty-six patients had some neurologic condition at baseline: 44 patients had intellectual disability (23 severe, 15 moderate, and six mild as clinically defined), 10 patients had cerebral palsy, 45 patients had epilepsy and 18 patients had at least a prior episode of status epilepticus. Thirty-nine patients (37%) did not have any history of a neurological disorder at baseline.
Acute causes included systemic infection in 26 patients (25.7%), fever without identifiable cause in 19 patients (18%), central nervous system infection in nine patients (8.6%), traumatic brain injury in six patients (5.7%), acute hypoxic-ischemic encephalopathy in five patients (4.8%), non-adherence to anticonvulsants in three patients (2.9%), electrolyte disturbance in two patients (2%). In 23 patients (22%) the acute cause was unknown. There were no data on etiologies for 12 patients.
CONCLUSIONS: Sixty-three percent of the patients with refractory convulsive status epilepticus had a previously established neurological condition, with developmental delay, intellectual disability and epilepsy being the most common. Acute causes most frequently included fever and infections. Identification of patients at risk may help design strategies for early intervention and status epilepticus prevention.
Study supported by: Epilepsy Foundation of America and by the American Epilepsy Society/Epilepsy Foundation of America Infrastructure Award.
Category - Epilepsy and Clinical Neurophysiology (EEG): Epidemiology
Wednesday, April 30, 2014 3:00 PM
S29: Platform Session: Epilepsy and Clinical Neurophysiology: Inflammation, Status Epilepticus, and Genetics (2:00 PM-3:45 PM)