Factors influencing control of convulsive status epilepticus in children

Abstract

Background: Convulsive status epilepticus (CSE) is an important cause of morbidity and mortality in pediatrics. Objectives: The objectives of the study were to examine the influence of any clinical factor on control of CSE in children. Methods: Cases of CSE in the age group of 1 month–12 years, admitted to the emergency ward of a tertiary care hospital, over a period of 1 year, were studied, prospectively. Only those cases that were actively convulsing at arrival were enrolled. Difficult cases were shifted pediatric intensive care unit and were put on mechanical ventilator as needed. After initial stabilization, detailed case-work up and appropriate investigations to find the etiology were done. The data were analyzed statistically and p<0.05 was considered as statistically significant. Results: The data of 50 cases that fulfilled the enrolment criteria were analyzed. Convulsions in the majority of the cases could be controlled within 30 min. Out of the study patients, 39 cases (78%) needed >1 drug for controlling the convulsive episodes. Control was extremely difficult in 10 (20%) of the cases while 3 (6%) cases died. The time needed to control the episodes showed significant correlation with several clinical factors, namely focal seizure with impaired consciousness, multiple episodes of convulsion (discrete type), focal deficit, Glasgow Coma Scale score <9, abnormal neuroimaging finding, central nervous system infections (meningitis and encephalitis together), and prolonged duration of convulsions before arrival at the emergency ward. However, on multivariate analysis prolonged duration of convulsion before arrival at emergency was found to be the most significant predictor of time needed to control the episodes. Conclusion: Prolonged duration of convulsion before arriving at the hospital can be considered to be a predictor of difficult control of CSE in children.