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Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience

Year 2022, Volume: 75 Issue: 4, 501 - 507, 20.01.2023

Abstract

Objectives: Status epilepticus (SE) is one of the most common neurologic emergencies in children. The aim of this study was to investigate the clinical and demographic characteristics, treatment protocols, and outcomes of patients in our pediatric intensive care unit (PICU).

Materials and Methods: Patients aged 1 month to 18 years, who were treated in the PICU with a diagnosis of SE between January 2020 and September 2021, were retrospectively evaluated. Demographics, indications for hospitalization, etiology, and types of SE, treatment modalities, mortality, and morbidity were recorded.

Results: Seventy two patients [29 (40.3%) female, 43 (59.7%) male] were enrolled in the study. The mean age of the patients was 11.78±12.87 months. Thirty-three (45.8%) patients were followed up with SE, 32 (44.4%) patients with refractory SE (RSE), and 7 (9.7%) patients with super RSE (SRSE). Most of the patients were in the age group of 1-5 years, and the most common etiology was remote symptomatic SE. Midazolam infusion was given to 40 (55.56%) patients, ketamine infusion to eight (11.11%) patients, thiopental infusion to seven (9.7%) patients, ketamine and propofol infusion to four (5%) patients, and valproic acid infusion to two (2.7%) patients. Seven patients (9.7%) died during the study, and the cause of death was due to their underlying diseases, independent of SE.

Conclusion: Timely recognition of SE and timely administration of appropriate medications are important in the follow-up of critically ill children. Chronic underlying diseases of patients followed up with RSE and SRSE affect prognosis and mortality.

Ethical Statement

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Thanks

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References

  • 1. Acer H, Canpolat M, Kumandaş S. Türkiye Klinikleri Çocukluk Çağı Epilepsileri. 2020:179-183.
  • 2. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56:1515–1523.
  • 3. Nilgün Erkek, Nilüfer Öztürk, Esra Şevketoğlu, et al. Status Epileptikus Tedavi Protokolü. Pediatr Emerg Intensive Care Med. 2020;7(Suppl-1):64-71.
  • 4. Zimmern V, Korff C. Status Epilepticus in Children. J Clin Neurophysiol. 2020;37:429-433.
  • 5. Silbergleit R, Lowenstein D, Durkalski V, et al. Lessons from the RAMPART study—and which is the best route of administration of benzodiazepines in status epilepticus. Epilepsia. 2013;54:74–77
  • 6. Erkek N, Öztürk N, Şevketoğlu E. Status Epilepticus Tedavi Protokolü. Çocuk Acil ve Yoğun Bakım Derneği Website. Ulaşılabilir: http: //www.cayd.org. tr/gorseller/files/protokoller/C%CC%A7AYD%20Status%20Epileptikus%20 protokolu%CC%88%20(01022018).pdf.2017.
  • 7. Chin RF, Neville BG, Peckham C, et al. Incidence, cause, and shortterm outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368:222–229
  • 8. Sánchez Fernández I, Abend NS, Agadi S, et al. Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure. 2014;23:87–97.
  • 9. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, populationbased epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996;46:1029–1035.
  • 10. Singh RK, Stephens S, Berl MM, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology. 2010;74:636–642.
  • 11. Barzegar M, Mahdavi M, Galegolab Behbehani A, et al. Refractory convulsive status epilepticus in children: etiology, associated risk factors and outcome. Iran J Child Neurol 2015;9:24–31.
  • 12. Lewena S, Young S. When benzodiazepines fail: how effective is second line therapy for status epilepticus in children. Emerg Med Australas. 2006;18:45– 50.
  • 13. Eriksson K, Metsaranta P, Huhtala H, et al. Treatment delay and the risk of prolonged status epilepticus. Neurology. 2005;65:1316–1318.
  • 14. Van Mater H. Pediatric inflammatory brain diseases: a diagnostic approach. Curr Opin Rheumatol. 2014;26:553–561.
  • 15. Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:391–404.
  • 16. Vasquez A, Farias-Moeller F, Tatum W. Pediatric refractory and superrefractory status epilepticus. Seizure. 2019;68:62-71.
  • 17. Zhao ZY, Wen B, Yang ZB, et al. A comparison of midazolam, lorazepam, and diazepam for the treatment of status epilepticus in children: a network meta-analysis. J Child Neurol. 2016;31:1093–1107.
  • 18. Abend NS, Bearden D, Helbig I, et al. Status epilepticus and refractory status epilepticus management. Semin Pediatr Neurol. 2014;21:263– 274.
  • 19. Aguilar CB, Fernández IS, Loddenkemper MP. Status Epilepticus—Work-Up and Management in Children. Semin Neurol. 2020;40: 661-674
  • 20. Abarrategui B, García-García ME, Toledano R, et al. Lacosamide for refractory generalized tonic–clonic seizures of non-focal origin in clinical practice: A clinical and VEEG study. Epilepsy & Behavior Case Reports. 2017;8:63-65.
  • 21. Rosa JSO, Ladino LD, Rodriquez PJ, et al. Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review. Seizure. 2018;56:34-40.
  • 22. Schubert-Bast S, Z€ollner JP, Ansorge S, et al. Burden and epidemiology of status epilepticus in infants, children, and adolescents: a population-based study on German health insurance data. Epilepsia. 2019;60:911–920.
  • 23. Sahin M, Menache CC, Holmes GL, et al. Outcome of severe refractory status epilepticus in children. Epilepsia. 2001;42:1461–1467.

Çocuk Yoğun Bakımda İzlenen Status Epileptikuslu Hastaların Değerlendirilmesi; Tek Merkez Deneyimimiz

Year 2022, Volume: 75 Issue: 4, 501 - 507, 20.01.2023

Abstract

Amaç: Status epileptikus (SE) çocukluk çağının en sık görülen nörolojik acillerindendir. Bu çalışmada çocuk yoğun bakım ünitemizde (ÇYBÜ) SE tanısıyla takip edilen hastaların klinik ve demografik özelliklerinin incelenmesi, tedavi protokolleri ve sonuçların değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Üçüncü basamak olarak hizmet veren ÇYBÜ’de Ocak 2020-Eylül 2021 tarihleri arasında SE nedeni ile takip edilen 1 ay-18 yaş arası hastalar retrospektif olarak incelendi. Hastaların demografik verileri, yatış endikasyonları, SE etiyoloji ve tipleri, uygulanan tedavi, mortalite ve morbidite durumları kaydedildi.

Bulgular: Çalışmaya 72 hasta [29 (%40,3) kız, 43 (%59,7) erkek] alındı. Hastaların yaş ortalaması 11,78±12,87 ay idi. Otuz üç (%45,8) hasta SE, 32 (%44,4) hasta refrakter SE (RSE), 7 (%9,7) hasta ise süper RSE (SRSE) ile takip edildi. En fazla hasta sayısı 1-5 yaş grubunda idi ve en sık SE etiyolojisi kronik statik santral sinir sistemi bozukluğu zemininde gelişen SE idi. Çalışmada 40 (%55,56) hastaya midazolam infüzyonu, sekiz (%11,11) hastaya ketamin infüzyonu, yedi (%9,7) hastaya tiopental infüzyonu, dört (%5) hastaya ketamin ve propofol infüzyonu, iki (%2,7) hastaya da valproik asid infüzyonu verildi. Tüm hastaların konvulziyonu kontrol altına alındı. Çalışmada yedi hasta (%9,7) kaybedildi. Bu hastaların ölüm sebebi SE’den bağımsız olarak altta yatan hastalıklarıydı.

Sonuç: SE’nin zamanında tanınması ve uygun medikasyonun zamanında yapılması kritik hasta çocuk takibinde önemlidir. RSE ve SRSE ile takip edilen hastaların altta yatan süreğen hastalıkları, prognoz ve mortaliteye etki etmektedir.

Ethical Statement

Çalışma için Toros Üniversitesi Etik Kurulu’ndan 28/01/2022 tarihli 6/1 sayılı etik kurul onamı alınmıştır.

Supporting Institution

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Project Number

-

Thanks

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References

  • 1. Acer H, Canpolat M, Kumandaş S. Türkiye Klinikleri Çocukluk Çağı Epilepsileri. 2020:179-183.
  • 2. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56:1515–1523.
  • 3. Nilgün Erkek, Nilüfer Öztürk, Esra Şevketoğlu, et al. Status Epileptikus Tedavi Protokolü. Pediatr Emerg Intensive Care Med. 2020;7(Suppl-1):64-71.
  • 4. Zimmern V, Korff C. Status Epilepticus in Children. J Clin Neurophysiol. 2020;37:429-433.
  • 5. Silbergleit R, Lowenstein D, Durkalski V, et al. Lessons from the RAMPART study—and which is the best route of administration of benzodiazepines in status epilepticus. Epilepsia. 2013;54:74–77
  • 6. Erkek N, Öztürk N, Şevketoğlu E. Status Epilepticus Tedavi Protokolü. Çocuk Acil ve Yoğun Bakım Derneği Website. Ulaşılabilir: http: //www.cayd.org. tr/gorseller/files/protokoller/C%CC%A7AYD%20Status%20Epileptikus%20 protokolu%CC%88%20(01022018).pdf.2017.
  • 7. Chin RF, Neville BG, Peckham C, et al. Incidence, cause, and shortterm outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368:222–229
  • 8. Sánchez Fernández I, Abend NS, Agadi S, et al. Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure. 2014;23:87–97.
  • 9. DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, populationbased epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996;46:1029–1035.
  • 10. Singh RK, Stephens S, Berl MM, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology. 2010;74:636–642.
  • 11. Barzegar M, Mahdavi M, Galegolab Behbehani A, et al. Refractory convulsive status epilepticus in children: etiology, associated risk factors and outcome. Iran J Child Neurol 2015;9:24–31.
  • 12. Lewena S, Young S. When benzodiazepines fail: how effective is second line therapy for status epilepticus in children. Emerg Med Australas. 2006;18:45– 50.
  • 13. Eriksson K, Metsaranta P, Huhtala H, et al. Treatment delay and the risk of prolonged status epilepticus. Neurology. 2005;65:1316–1318.
  • 14. Van Mater H. Pediatric inflammatory brain diseases: a diagnostic approach. Curr Opin Rheumatol. 2014;26:553–561.
  • 15. Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:391–404.
  • 16. Vasquez A, Farias-Moeller F, Tatum W. Pediatric refractory and superrefractory status epilepticus. Seizure. 2019;68:62-71.
  • 17. Zhao ZY, Wen B, Yang ZB, et al. A comparison of midazolam, lorazepam, and diazepam for the treatment of status epilepticus in children: a network meta-analysis. J Child Neurol. 2016;31:1093–1107.
  • 18. Abend NS, Bearden D, Helbig I, et al. Status epilepticus and refractory status epilepticus management. Semin Pediatr Neurol. 2014;21:263– 274.
  • 19. Aguilar CB, Fernández IS, Loddenkemper MP. Status Epilepticus—Work-Up and Management in Children. Semin Neurol. 2020;40: 661-674
  • 20. Abarrategui B, García-García ME, Toledano R, et al. Lacosamide for refractory generalized tonic–clonic seizures of non-focal origin in clinical practice: A clinical and VEEG study. Epilepsy & Behavior Case Reports. 2017;8:63-65.
  • 21. Rosa JSO, Ladino LD, Rodriquez PJ, et al. Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review. Seizure. 2018;56:34-40.
  • 22. Schubert-Bast S, Z€ollner JP, Ansorge S, et al. Burden and epidemiology of status epilepticus in infants, children, and adolescents: a population-based study on German health insurance data. Epilepsia. 2019;60:911–920.
  • 23. Sahin M, Menache CC, Holmes GL, et al. Outcome of severe refractory status epilepticus in children. Epilepsia. 2001;42:1461–1467.
There are 23 citations in total.

Details

Primary Language English
Subjects Pediatric Intensive Care
Journal Section Articles
Authors

Merve Havan This is me 0000-0003-3431-7906

Project Number -
Publication Date January 20, 2023
Published in Issue Year 2022 Volume: 75 Issue: 4

Cite

APA Havan, M. (2023). Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 75(4), 501-507. https://doi.org/10.4274/atfm.galenos.2022.57855
AMA Havan M. Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience. Ankara Üniversitesi Tıp Fakültesi Mecmuası. January 2023;75(4):501-507. doi:10.4274/atfm.galenos.2022.57855
Chicago Havan, Merve. “Evaluation of Patients With Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-Center Experience”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75, no. 4 (January 2023): 501-7. https://doi.org/10.4274/atfm.galenos.2022.57855.
EndNote Havan M (January 1, 2023) Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75 4 501–507.
IEEE M. Havan, “Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 4, pp. 501–507, 2023, doi: 10.4274/atfm.galenos.2022.57855.
ISNAD Havan, Merve. “Evaluation of Patients With Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-Center Experience”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75/4 (January2023), 501-507. https://doi.org/10.4274/atfm.galenos.2022.57855.
JAMA Havan M. Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;75:501–507.
MLA Havan, Merve. “Evaluation of Patients With Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-Center Experience”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 4, 2023, pp. 501-7, doi:10.4274/atfm.galenos.2022.57855.
Vancouver Havan M. Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2023;75(4):501-7.