Etiology of Pediatric Refractory Convulsive Status Epilepticus. Results from the Pediatric Status Epilepticus Research Group (pSERG) (S29.005)

Abstract

OBJECTIVE: To describe the etiologies of refractory convulsive status epilepticus in children. BACKGROUND: There are limited data on the causative and contributory conditions in children with refractory convulsive status epilepticus. DESIGN/METHODS: This prospective multicenter cohort study characterizes the pre-existing conditions and acute seizure cause of refractory convulsive status epilepticus. Inclusion criteria: 1) admitted between June 2011 and September 2013, 2) age from 1 month to 21 years, 3) convulsive seizures at onset, and 4) failure of 蠅 2 AEDs to terminate seizures or the initiation of a continuous infusion of medications for seizure control. Exclusion criteria: Non-convulsive status epilepticus. RESULTS: 105 cases in 105 patients (54 males) with a mean (SD) of 5.6 (±5.3) years were enrolled in the study. Sixty-six patients had some neurologic condition at baseline: 44 patients had intellectual disability (23 severe, 15 moderate, and six mild as clinically defined), 10 patients had cerebral palsy, 45 patients had epilepsy and 18 patients had at least a prior episode of status epilepticus. Thirty-nine patients (37%) did not have any history of a neurological disorder at baseline. Acute causes included systemic infection in 26 patients (25.7%), fever without identifiable cause in 19 patients (18%), central nervous system infection in nine patients (8.6%), traumatic brain injury in six patients (5.7%), acute hypoxic-ischemic encephalopathy in five patients (4.8%), non-adherence to anticonvulsants in three patients (2.9%), electrolyte disturbance in two patients (2%). In 23 patients (22%) the acute cause was unknown. There were no data on etiologies for 12 patients. CONCLUSIONS: Sixty-three percent of the patients with refractory convulsive status epilepticus had a previously established neurological condition, with developmental delay, intellectual disability and epilepsy being the most common. Acute causes most frequently included fever and infections. Identification of patients at risk may help design strategies for early intervention and status epilepticus prevention. Study supported by: Epilepsy Foundation of America and by the American Epilepsy Society/Epilepsy Foundation of America Infrastructure Award.

Disclosure: Dr. Gaillard has received personal compensation for activities with King Pharmaceutical as a member of an advisory board, and Questcor. Dr. Goodkin has received personal compensation in an editorial capacity for Up To Date. Dr. Abend has nothing to disclose. Dr. Agadi has nothing to disclose. Dr. Arya has nothing to disclose. Dr. Basu has nothing to disclose. Dr. Carpenter has nothing to disclose. Dr. Chapman has nothing to disclose. Dr. Dean has nothing to disclose. Dr. Glauser has received personal compensation for activities with Supernus, Sunovion Pharmaceuticals, Eisai Inc., UCB Pharma, Lundbeck, Questcor, Upsher-Smith, AssureRx Health, and GeneDx. Dr. Glauser has received royalty, or license fee, or contractual rights payments from AssureRx Health. Dr. Jackson has nothing to disclose. Dr. Mikati has nothing to disclose. Dr. Peariso has nothing to disclose. Dr. Rathore has nothing to disclose. Dr. Sanchez Fernandez has nothing to disclose. Dr. Tasker has nothing to disclose. Dr. Topjian has nothing to disclose. Dr. Turner has nothing to disclose. Dr. Wilfong has received personal compensation for activities with Cyberonics and Eisai Inc. as a speaker, and Cyberonics and Lundbeck as a consultant. Dr. Wilfong has received research support from Cyberonics, Moody Foundation, Eisai Inc., Pfizer Inc., and Novartis. Dr. Williams has nothing to disclose. Dr. Loddenkemper has received personal compensation in an editorial capacity for Seizure. Dr. Loddenkemper has received research support from the National Institutes of Health, the Payer Provider Quality Initiative, The Epilepsy Foundation of America, the Center for Integration of Medicine and Innovative Technology, the Epilepsy Therapy Project, the American Epilepsy Society, The Pediatric Epilepsy Research Foundation, Cure, Lundbeck Research USA, Inc., and Eisai Inc.