Features predicting adverse outcomes of status epilepticus in childhood

KL Kwong, K Chang, SY Lam
Department of Paediatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong

OBJECTIVE. To examine variables that might predict abnormal outcome of status epilepticus among children.

DESIGN. Retrospective study.

SETTING. Regional hospital, Hong Kong.

PATIENTS. All children younger than 15 years who were admitted to the paediatric intensive care unit with status epilepticus between 1997 and 2002.

MAIN OUTCOME MEASURES. Neurodevelopmental outcomes.

RESULTS. Two of the 25 patients died, resulting in a mortality rate of 8%. No deaths were due to status epilepticus itself. No patient with febrile or idiopathic status epilepticus developed epilepsy. Neurological deterioration was observed in a quarter (six of 23) of the survivors. Symptomatic aetiology (acute or remote) and refractory status epilepticus were associated with adverse outcomes (P<0.05). Young age at status epilepticus (<12 months) and duration of status epilepticus (>60 minutes) tended to be more frequent among those who developed adverse outcome. Rectal diazepam was given before hospital arrival in only four patients.

CONCLUSIONS. Paediatric patients with status epilepticus who had normal neurodevelopmental status before the onset of an attack and who did not sustain an acute insult to the central nervous system or have progressive encephalopathy, had favourable outcomes. Prompt use of rectal diazepam or buccal midazolam administered by caretakers or paramedics should be encouraged.

Hong Kong Med J 2004;10:156-9

Key words: Child; Infant; Status epilepticus