Download PDF
Journal of Pediatric Epilepsy
DOI: 10.1055/s-0044-1787859
Original Article

Status Epilepticus in Children at a Tertiary Care Center in India: Etiology, Preventable Risk Factors, and Short-Term Outcome

Kejal Merani
1   Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC & GH), Mumbai, Maharashtra, India
,
Sanjeevani Satish Masavkar
1   Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital (LTMMC & GH), Mumbai, Maharashtra, India
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Introduction Status epilepticus (SE) is a common neurological emergency in children. Recent guidelines suggest initiating treatment after 5 minutes of seizure activity.

Objective This study analyzes the clinical, laboratory parameters, and treatment outcomes of children with SE to identify preventable risk factors.

Materials and Methods Prospective observational study of 150 children. They were evaluated for relevant history, clinical features, laboratory investigations, treatment, course, and outcome.

Results The risk factors that had an impact on outcome in children with SE were identified as red flag signs on initial pediatric advanced life support (PALS) assessment, malnutrition, abnormal head circumference and number of seizures before child presented to hospital. The strongest predictor of outcome was stable status of children on initial PALS assessment (odds ratio = 20.174 [1.117, 364.393], p = 0.042). Presence of abnormal head size was 86% less likely to have favorable outcome and if the child had lesser number of seizures before child presented to hospital (single), it was 3.7 times likely that it would yield a favorable outcome.

Conclusion Aggressive treatment of seizures, identification of red flag signs on initial PALS assessment, identification and treatment of malnutrition, anemia, hypocalcemia, and sodium derangements, strengthening vaccination to prevent central nervous system infections, and early intervention for developmental delay, can all help to combat morbidity and mortality in children with SE.

Keywords

status epilepticus - children - risk factors

Authors' Contributions

S.S.M., K.M.: Concept and design of the study, data compilation and analysis, manuscript writing; K.M.: data analysis and interpretation, manuscript writing, and final editing. All the authors have read and approved the final version of the manuscript.




Publication History

Received: 27 November 2023

Accepted: 08 May 2024

Article published online:
25 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Wang T, Wang J, Dou Y. et al; Chinese Paediatric Status Epilepticus Task Force. Clinical characteristics and prognosis in a large paediatric cohort with status epilepticus. Seizure 2020; 80: 5-11
    CrossrefPubMedGoogle Scholar
  • 2 Sánchez Fernández I, Abend NS, Agadi S. et al; Pediatric Status Epilepticus Research Group (pSERG). Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure 2014; 23 (02) 87-97
    CrossrefPubMedGoogle Scholar
  • 3 Trinka E, Cock H, Hesdorffer D. et al. A definition and classification of status epilepticus–report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56 (10) 1515-1523
    CrossrefPubMedGoogle Scholar
  • 4 Shinnar S, Pellock JM, Moshé SL. et al. In whom does status epilepticus occur: age-related differences in children. Epilepsia 1997; 38 (08) 907-914
    CrossrefPubMedGoogle Scholar
  • 5 Gulati S, Kalra V, Sridhar MR. Status epilepticus in Indian children in a tertiary care center. Indian J Pediatr 2005; 72 (02) 105-108
    CrossrefPubMedGoogle Scholar
  • 6 Prakash AT, Shruthi TK, Ps R, Sankaranarayanan S. Profile on status epilepticus, clinical features and lab parameters and outcome in pediatric intensive care. Int J Contemp Pediatrics 2017; 4 (04) 1310-1316
    CrossrefPubMedGoogle Scholar
  • 7 Raspall-Chaure M, Chin RF, Neville BG, Scott RC. Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol 2006; 5 (09) 769-779
    CrossrefPubMedGoogle Scholar
  • 8 Sánchez S, Rincon F. Status epilepticus: epidemiology and public health needs. J Clin Med 2016; 5 (08) 71
    CrossrefPubMedGoogle Scholar
  • 9 Kravljanac R, Jovic N, Tadic BV, Kravljanac D, Pekmezovic T. New-onset seizure presenting as status epilepticus: Etiology and clinical characteristics in a cohort of 236 children. Seizure 2018; 63: 79-84
    CrossrefPubMedGoogle Scholar
  • 10 DeLorenzo RJ, Towne AR, Pellock JM, Ko D. Status epilepticus in children, adults, and the elderly. Epilepsia 1992; 33 (Suppl. 04) S15-S25
    CrossrefPubMedGoogle Scholar
  • 11 Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. NLSTEPSS Collaborative Group. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 2006; 368 (9531) 222-229
    CrossrefPubMedGoogle Scholar
  • 12 Hauser WA, Anderson VE, Loewenson RB, McRoberts SM. Seizure recurrence after a first unprovoked seizure. N Engl J Med 1982; 307 (09) 522-528
    CrossrefPubMedGoogle Scholar
  • 13 Lewena S, Pennington V, Acworth J. et al. Emergency management of pediatric convulsive status epilepticus: a multicenter study of 542 patients. Pediatr Emerg Care 2009; 25 (02) 83-87
    CrossrefPubMedGoogle Scholar
  • 14 Rainbow J, Browne GJ, Lam LT. Controlling seizures in the prehospital setting: diazepam or midazolam?. J Paediatr Child Health 2002; 38 (06) 582-586
    CrossrefPubMedGoogle Scholar
  • 15 Aicardi J, Chevrie JJ. Convulsive status epilepticus in infants and children. A study of 239 cases. Epilepsia 1970; 11 (02) 187-197
    CrossrefPubMedGoogle Scholar
  • 16 Riviello Jr JJ, Ashwal S, Hirtz D. et al; American Academy of Neurology Subcommittee, Practice Committee of the Child Neurology Society. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2006; 67 (09) 1542-1550
    CrossrefPubMedGoogle Scholar
  • 17 Brophy GM, Bell R, Claassen J. et al; Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17 (01) 3-23
    CrossrefPubMedGoogle Scholar
  • 18 Mishra D, Sharma S, Sankhyan N. et al. For the ‡ Multi-Disciplinary Group on Management, of Status Epilepticus in Children in India. Consensus guidelines on management of childhood convulsive status epilepticus. Indian Pediatr 2014; 51 (12) 975-990
    CrossrefPubMedGoogle Scholar
  • 19 Glauser T, Shinnar S, Gloss D. et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: Report of the guideline committee of the American Epilepsy Society. Epilepsy Curr 2016; 16 (01) 48-61
    CrossrefPubMedGoogle Scholar
  • 20 Chin RF, Neville BG, Peckham C, Wade A, Bedford H, Scott RC. Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol 2008; 7 (08) 696-703
    CrossrefPubMedGoogle Scholar
  • 21 Murthy JMK, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia 2007; 48 (12) 2217-2223
    CrossrefPubMedGoogle Scholar
  • 22 Trinka E, Höfler J, Zerbs A. Causes of status epilepticus. Epilepsia 2012; 53 (Suppl. 04) 127-138
    CrossrefPubMedGoogle Scholar
  • 23 Brunquell PJ, Glennon CM, DiMario Jr FJ, Lerer T, Eisenfeld L. Prediction of outcome based on clinical seizure type in newborn infants. J Pediatr 2002; 140 (06) 707-712
    CrossrefPubMedGoogle Scholar
  • 24 Neligan A, Shorvon SD. Prognostic factors, morbidity and mortality in tonic-clonic status epilepticus: a review. Epilepsy Res 2011; 93 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 25 Loddenkemper T, Syed TU, Ramgopal S. et al. Risk factors associated with death in in-hospital pediatric convulsive status epilepticus. PLoS One 2012; 7 (10) e47474
    CrossrefPubMedGoogle Scholar
  • 26 Bertoli S, Cardinali S, Veggiotti P, Trentani C, Testolin G, Tagliabue A. Evaluation of nutritional status in children with refractory epilepsy. Nutr J 2006; 5 (01) 14
    CrossrefPubMedGoogle Scholar
  • 27 Claassen J, Lokin JK, Fitzsimmons BFM, Mendelsohn FA, Mayer SA. Predictors of functional disability and mortality after status epilepticus. Neurology 2002; 58 (01) 139-142
    CrossrefPubMedGoogle Scholar
  • 28 Hartfield DS, Tan J, Yager JY. et al. The association between iron deficiency and febrile seizures in childhood. Clin Pediatr (Phila) 2009; 48 (04) 420-426
    CrossrefPubMedGoogle Scholar
  • 29 Xie Y, Tian R, Xie H. et al. The clinical significance of thrombocytopenia complicating sepsis: a meta-analysis. J Infect 2019; 78 (04) 323-337
    CrossrefPubMedGoogle Scholar
  • 30 Castilla-Guerra L, del Carmen Fernández-Moreno M, López-Chozas JM, Fernández-Bolaños R. Electrolytes disturbances and seizures. Epilepsia 2006; 47 (12) 1990-1998
    CrossrefPubMedGoogle Scholar
  • 31 Han P, Trinidad BJ, Shi J. Hypocalcemia-induced seizure: demystifying the calcium paradox. ASN Neuro 2015; 7 (02) 1-9
    PubMedGoogle Scholar
  • 32 Chin RFM, Neville BGR, Scott RC. Meningitis is a common cause of convulsive status epilepticus with fever. Arch Dis Child 2005; 90 (01) 66-69
    CrossrefPubMedGoogle Scholar
  • 33 Raspall-Chaure M, Chin RFM, Neville BG, Bedford H, Scott RC. The epidemiology of convulsive status epilepticus in children: a critical review. Epilepsia 2007; 48 (09) 1652-1663
    CrossrefPubMedGoogle Scholar
  • 34 Maegaki Y, Kurozawa Y, Tamasaki A. et al; Status Epilepticus Study Group. Early predictors of status epilepticus-associated mortality and morbidity in children. Brain Dev 2015; 37 (05) 478-486
    CrossrefPubMedGoogle Scholar
  • 35 Sculier C, Gaínza-Lein M, Sánchez Fernández I, Loddenkemper T. Long-term outcomes of status epilepticus: A critical assessment. Epilepsia 2018; 59 (Suppl. 02) 155-169
    CrossrefPubMedGoogle Scholar
  • 36 Kravljanac R, Jovic N, Djuric M, Jankovic B, Pekmezovic T. Outcome of status epilepticus in children treated in the intensive care unit: a study of 302 cases. Epilepsia 2011; 52 (02) 358-363
    CrossrefPubMedGoogle Scholar