Annual Meeting Abstracts: View
(Abst. 1.137), 2015
Clinical characteristics and outcome of status epilepticus in patients with and without a prior diagnosis of epilepsy
Authors: Michele Jackson, Iván Sánchez Fernández, Nicholas Abend, Ravindra Arya, James N. Brenton, Jessica Carpenter, Kevin Chapman, William D. Gaillard, Tracy Glauser, Joshua Goldstein, Howard Goodkin, Ashley Helseth, Mohamad Mikati, Katrina Peariso, Robert Tasker, Alexis Topjian, Mark Wainwright, Angus Wilfong, Korwyn Williams, Tobias Loddenkemper
Content: Rationale: The aim of this study is to compare the management and outcome of pediatric refractory status epilepticus (RSE) in children with and without a prior diagnosis of epilepsy.Methods: Prospective observational descriptive study performed from June 2011 to May 2015. Pediatric patients (1 month to 21 years) with refractory convulsive SE were enrolled. We compared the time to administration of the first antiepileptic drugs, SE duration, and short-term outcome in children with and without a prior diagnosis of epilepsy. Continuous data are presented as median (p25-p75) and analyzed using the Wilcoxon rank-sum test. Proportions were analyzed using Fisher’s exact test.Results: We enrolled 194 patients (54.1% males) with a median (p25-p75) age of 4.3 (1.3-10.2) years. There were 84 children (54.8% males) with known epilepsy and 110 children (53.6% males) without a prior diagnosis of epilepsy. The median (p25-p75) time to the first benzodiazepine was 20 (5-50) minutes, with no differences in patients with and without a prior diagnosis of epilepsy [16 (5-70) minutes versus 20 (7-42) minutes, Wilcoxon rank-sum test p=0.8826]. The median (p25-p75) time to receive the first non-benzodiazepine AED was 65 (34-161) minutes, with a significantly longer time to administration in patients with a prior diagnosis of epilepsy [93 (46-200) minutes versus 50.5 (30-120) minutes, Wilcoxon rank-sum test, p=0.0033]. Patients without a prior diagnosis of epilepsy tended to be intubated more often than patients with known epilepsy [75% versus 65.5%, Fisher’s exact test, p=0.106]. The return to the pre-SE function as clinically evaluated, occurred in 132 (71.7%) patients, did not occur in 41 (22.3%), and was unclear in 11 (6%). Patients with epilepsy had a more frequent return to baseline than patients without a prior history of epilepsy [84.4% versus 69.8%, Fisher’s exact test, p=0.018]. The median (p25-p75) duration of convulsive SE was 136 minutes (60-300) minutes. There was a tendency towards longer duration of SE in children with a prior diagnosis of epilepsy [174 (75-390) minutes versus 120 (49-240) minutes, Wilcoxon rank-sum test, p=0.0768]. A total of 6 patients died before leaving the hospital and 5 of the deaths occurred in patients with no history of epilepsy.Conclusions: Pediatric patients who present in SE with a prior diagnosis of epilepsy receive slower first non-benzodiazepine therapy, but tend to have better outcomes (This study was funded by an AES/Epilepsy Foundation of America infrastructure award).