Convulsive status epilepticus in Thai children at Ramathibodi Hospital

Abstract

Background: Convulsive Status Epilepticus (SE) is an emergency neurological condition with high morbidity and mortality. The outcome of this condition in children depends on the etiology and the duration of convulsion. There is no report of this condition in Thai children.

Objective: To study the etiology, clinical course and outcome in children with convulsive SE in a referral hospital in Thailand.

Material and method: The medical records of infants and children aged between one month and 15 years with the diagnosis of SE who were admitted to the Department of Pediatrics, Ramathibodi Hospital, Bangkok from January 1st, 1981 to December 31st, 2000 were retrospectively reviewed. The demographic data, types of seizure, duration of seizure, underlying diseases, precipitating factors, laboratory results, treatment, clinical course and outcomes were collected for descriptive analysis.

Results: Thirty-two patients (15 boys, 17 girls) whose ages ranged from 2 months to 14.4 years (mean 6.5 years) were included Twenty-four patients had underlying epilepsy. Twelve patients had prior diagnosis of symptomatic and idiopathic/cryptogenic epilepsy. Seven patients had acute insults to the central nervous system leading to SE. One patient with acute lymphoblastic leukemia presented with SE without association to either the underlying disease or the treatment. Fever with or without specific infection was the most common precipitating factor observed in these patients. The mean duration of SE was 64.4 minutes. The mean duration from initiation of treatment to the cessation of seizure was 41.4 minutes. Twelve patients were lost to follow up. Of the two patients who died, one had severe infection and the other had renal failure. Twelve patients had severe neurological deficits and six had mild neurological deficits. Among the thirteen patients who had > or = 1 hour of convulsion, eleven had severe neurological deficits or died.

Conclusion: Infantile SE occurred more frequently in children with pre-existing epilepsy or neurological disorder Acute febrile illness and infection were the most common precipitating causes in the present study. Early recognition and treatment of fever and infection in conjunction with prompt and appropriate termination of seizure in epileptic children may prevent the occurrence of SE and its morbidity.