Evaluation of Patients with Status Epilepticus in The Pediatric Intensive Care Unit; Our Single-center Experience
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.
Keywords
Status Epilepticus, Pediatric Intensive Care, Antiepileptic Drugs
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.