Prognostic factors of status epilepticus in children

Abstract

We retrospectively reviewed the medical records of 189 children who were admitted to the Pediatric Neurology Department at Yonsei University College of Medicine with status epilepticus (SE) between April, 1994 and April, 2003. The children were followed up for a mean duration of 17 months. We analyzed the clinical findings and the relationships between neurologic sequelae, recurrence, age of onset, presumptive causes, types of seizure, seizure duration and the presence of fever. Mean age at SE onset was 37 months. Incidences by seizure type classification were generalized convulsive SE in 73.5%, and non-convulsive SE in 26.5%. The incidences of presumptive causes of SE were idiopathic 40.7%, epilepsy 29.1%, remote 16.4% and acute symptomatic in 13.3%. Among all the patients, febrile episodes occurred in 35.4%, especially in patients under 3 year old, and 38.4% of these were associated with febrile illness regardless of presumptive cause. Neurologic sequelae occurred in 33% and the mortality rate was 3%. Neurologic sequelae were lower in patients that presented with an idiopathic etiology and higher in generalized convulsive SE patients. The recurrence of SE was higher in patients with a remote symptomatic epileptic etiology, and generalized convulsive SE showed higher rates of recurrence. Based on this retrospective study, the neurologic outcomes and recurrence of SE were found to be strongly associated with etiology and seizure type. Age, seizure duration and the presence of febrile illness were found to have no effect on outcome.

Fig. 1

Age and sex distributions of the patients.

Fig. 2

Etiologies of SE in children. Etiologies included Idiopathic, Acute symptomatic (CNS infection, Metabolic, Anoxia, ICH, Trauma), Remote (Remote symptomatic), and Epilepsy. Data are expressed as the numbers and percentages of cases with each etiology.

Fig. 3

Neurologic outcomes according to etiologies. Etiologies included Idiop (Idiopathic), Acute symptomatic, Remote symptomatic and Epilepsy. Neurologic sequelae including motor and cognitive deficits and significantly lower in those with an idiopathic etiology than in those with other causes (^*p < 0.01).