Aborted and refractory status epilepticus in children: A comparative analysis

被引:80
作者
Lambrechtsen, Florise A. C. P. [2 ]
Buchhalter, Jeffrey R. [1 ]
机构
[1] Mayo Clin, Dept Neurol, Rochester, MN USA
[2] Univ Groningen, Univ Med Ctr Groningen, NL-9713 AV Groningen, Netherlands
关键词
status epilepticus; refractory status epilepticus; children; epilepsy;
D O I
10.1111/j.1528-1167.2007.01465.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose: The aims of this retrospective study were: (1) to compare the demographics, clinical characteristics, etiology, and EEG findings of status epilepticus aborted with medication (ASE) and refractory status epilepticus (RSE), (2) to describe the treatment response of status epilepticus (SE), and (3) to determine predictors of long-term outcome in children with SE. Methods: Medical records and EEG lab logs with ICD-9 diagnostic codes related to SE were reviewed. Patients younger than 18 years of age, hospitalized in 1994-2004 at the Mayo Clinic, Rochester, were included. Results: One hundred fifty-four children had SE; 94 (61%) had ASE, and 60 (39.0%) had RSE. Family history of seizures, higher seizure frequency score, higher number of maintenance antiepileptic drugs (AEDs), nonconvulsive SE, and focal or electrographic seizures on initial EEG were associated with RSE by univariate analysis. In-hospital mortality was significantly higher in RSE (13.3%) than in ASE (2.1%). In the long term, survivors with RSE developed more new neurological deficits (p < 0.001) and more epilepsy (p < 0.004) than children with ASE. Children treated in a more aggressive fashion appeared to have better treatment responses (p < 0.001) and outcomes (p = 0.03). Predictors of poor outcome were long seizure duration (p < 0.001), acute symptomatic etiology (p = 0.04), nonconvulsive SE (NCSE) (p = 0.01), and age at admission < 5 years (p = 0.05). Discussion: Several patient and clinical characteristics are associated with development of RSE and poor outcome. Prospective, randomized trials that assess different treatment protocols in children with SE are needed to determine the optimal sequence and timing of medications.
引用
收藏
页码:615 / 625
页数:11
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