OUTCOMES OF REFRACTORY STATUS EPILEPTICUS IN CHILDREN

Abstract

Objective: To determine the outcome of Refractory Status Epilepticus (RSE) in children and the factors affecting the outcome.

Study Design: Cross-sectional study.

Place and Duration of Study: High Dependency Unit of Pediatrics Neurology Department at the Children’s Hospital and Institute of Child Health, from Aug 2019 to Mar 2020.

Methodology: This study was conducted on the children presenting with refractory status epilepticus. Structured proforma was used for recording predictive factors. Modified Rankin scale prior to the presentation and Glasgow Coma Scale at presentation were documented and compared with the discharge scores.

Results: Out of 75 children, 46 (61.4%) were males with mean age of 4.43 ± 3.47 years. Common etiologies were acute symptomatic in 37 (49.3%), progressive encephalopathy in 19 (25.3%), static encephalopathy in 9 (11.9%), remote symptomatic in 4 (5.3%), acute on remote symptomatic in 3 (4.0%), idiopathic and unclassified in remaining patients. Mean time between seizures onset and first benzodiazepine injection was 44 ± 36 minutes. Duration of RSE was <24 hours in 17 (22.7%), 24-48 hours in 15 (20.0%), 48-72 hours in 14 (18.6%), 72-96 hours in 12 (16%) and >96 hours in 17 (22.7%). At discharge 33 (44%) returned to baseline, 31 (41%) developed neurological disability while 11 (15%) expired during the stay. Etiology and duration of status epilepticus had significant impact on outcome with p-value of 0.021 and 0.041, respectively.

Conclusion: Acute etiology was associated with higher mortality whereas return to baseline was also fair among survivors. This poses implications for emergency management to significantly............