Observational Study

. 2017 Jan 24;88(4):386-394.

doi: 10.1212/WNL.0000000000003550. Epub 2016 Dec 23.

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Iván Sánchez Fernández¹, Michele C Jackson¹, Nicholas S Abend¹, Ravindra Arya¹, James N Brenton¹, Jessica L Carpenter¹, Kevin E Chapman¹, William D Gaillard¹, Marina Gaínza-Lein¹, Tracy A Glauser¹, Joshua L Goldstein¹, Howard P Goodkin¹, Ashley Helseth¹, Kush Kapur¹, Tiffani L McDonough¹, Mohamad A Mikati¹, Katrina Peariso¹, James Riviello Jr¹, Robert C Tasker¹, Alexis A Topjian¹, Mark S Wainwright¹, Angus Wilfong¹, Korwyn Williams¹, Tobias Loddenkemper²; pediatric Status Epilepticus Research Group (pSERG)

Affiliations

¹ From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ.
² From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ. tobias.loddenkemper@childrens.harvard.edu.

PMID: 28011930
PMCID: PMC5272971
DOI: 10.1212/WNL.0000000000003550

Observational Study

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Iván Sánchez Fernández et al. Neurology. 2017.

. 2017 Jan 24;88(4):386-394.

doi: 10.1212/WNL.0000000000003550. Epub 2016 Dec 23.

Authors

Affiliations

¹ From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ.
² From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., M.C.J., M.G.L., K.K., T.L.), and Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, Universidad de Barcelona, Spain; Division of Neurology (N.S.A., A.A.T.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; Cincinnati Children's Hospital Medical Center (R.A., T.A.G., K.P.), University of Cincinnati, OH; Department of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; Universidad Austral de Chile (M.G.L.), Valdivia, Chile; Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program (J.L.G., M.S.W.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Pediatric Neurology (A.H., M.A.M.), Duke University Medical Center, Duke University, Durham, NC; Division of Child Neurology (T.L.M., J.R.), Department of Neurology, Columbia University Medical Center, Columbia University, New York, NY; Section of Neurology and Developmental Neuroscience (A.W.), Department of Pediatrics, Baylor College of Medicine, Houston, TX; Barrows Neurological Institute (K.W.), Phoenix Children's Hospital; Department of Pediatrics (K.W.), University of Arizona School of Medicine, Tucson; and Department of Neurology (K.W.), Mayo Clinic, Scottsdale, AZ. tobias.loddenkemper@childrens.harvard.edu.

PMID: 28011930
PMCID: PMC5272971
DOI: 10.1212/WNL.0000000000003550

Abstract

Objective: To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).

Methods: This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE.

Results: We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.2 (1.3-9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [5-60] vs 16.5 [5-42.75] minutes, p = 0.858). Patients with a diagnosis of epilepsy received their first non-benzodiazepine (BZD) antiepileptic drug (AED) later (93 [46-190] vs 50.5 [28-116] minutes, p = 0.002) and were less likely to receive at least one continuous infusion (35/89 [39.3%] vs 57/100 [57%], p = 0.03). Compared to patients with no history of SE, patients with a history of SE received their first BZD earlier (8 [3.5-22.3] vs 20 [5-60] minutes, p = 0.0073), although they had a similar time to first non-BZD AED (76.5 [45.3-124] vs 65 [32.5-156] minutes, p = 0.749). Differences were mostly driven by the patients with an out-of-hospital rSE onset.

Conclusions: Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication.

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Figures

**Figure 1. Cumulative probability curves representing time to receive medications for status epilepticus (SE) comparing patients with and without epilepsy**
The left column represents the time to receive the first benzodiazepine (BZD), the middle column the time to receive the first non-BZD antiepileptic drug (AED), and the right column the time to receive the first continuous infusion (CI). (A) Whole population. (B) Onset of SE out of the hospital. (C) Onset of SE in the hospital. X-axis arbitrarily truncated at 150 minutes (time to first BZD), at 200 minutes (time to first non-BZD AED), and at 800 minutes (time to first CI) for clarity (outliers not shown in the figure, but evaluated for its calculation).

**Figure 2. Cumulative probability curves representing time to receive medications for status epilepticus (SE) comparing patients with and without a history of SE**
The left column represents the time to receive the first benzodiazepine (BZD), the middle column the time to receive the first non-BZD antiepileptic drug (AED), and the right column the time to receive the first continuous infusion (CI). (A) Whole population. (B) Onset of SE out of the hospital. (C) Onset of SE in the hospital. X-axis arbitrarily truncated at 150 minutes (time to first BZD), at 200 minutes (time to first non-BZD AED), and at 800 minutes (time to first CI) for clarity (outliers not shown in the figure, but evaluated for its calculation).

See this image and copyright information in PMC

References

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Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Affiliations

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Molecular Biology Databases