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(Abst. 2.183), 2015

Factors associated with status epilepticus duration in children
Authors: Tobias Loddenkemper, Iván Sánchez Fernández, Michele Jackson, Nicholas Abend, Ravindra Arya, J. Nicholas Brenton, Jessica Carpenter, Kevin Chapman, William D. Gaillard, Tracy Glauser, Joshua Goldstein, Howard Goodkin, Ashley Helseth, Mohamad Mikati, Katrina Peariso, Alexis Topjian, Mark Wainwright, Angus Wilfong, Korwyn Williams, Robert Tasker
Content: Rationale: The aim of this study was to identify factors associated with the duration of pediatric convulsive status epilepticus (SE).Methods: Prospective observational descriptive study performed from June 2011 to May 2015. Pediatric subjects (1 month to 21 years) with refractory convulsive SE were enrolled. We considered the duration of convulsive seizures as the main outcome and evaluated predictors for SE duration.Results: We enrolled 190 subjects (54.2% males) with a median (p25-p75) age of 4.1 (1.3-10.2) years. The median (p25-p75) duration of SE was 140 (60-300) minutes. SE etiology was structural (36.9%), genetic or metabolic (21.9%), and unknown (41.3%). 94 subjects had developmental delay, 83 subjects had epilepsy, 33 subjects had at least a prior episode of SE, 18 subjects had cerebral palsy, and 18 subjects had history of febrile seizures. The SE episode was continuous in 29.7% of subjects and intermittent in 70.3% of subjects. On univariate analysis, SE duration was associated with AED choice (non-recommended versus recommended treatment strategy) (p= 0.0123), time to first BZD (p<0.001), time to first non-BZD AED (p<0.001), time to EMS arrival at the patient (p= 0.0103), time of hospital arrival for the patient (p<0.001), age (p= 0.0218), type of SE (intermittent versus continuous) (p<0.001), and SE onset (out-of the hospital versus in-hospital) (p= 0.0188). SE duration was note associated with gender (p= 0.4925) or etiology (structural versus genetic or metabolic versus unknown) (p= 0.7266) (Table 1). All variables were included in multivariable regression due to our a priori analysis plans. Multivariable median regression analysis showed that the only variables which remained significantly associated with SE duration were structural etiology (versus genetic/metabolic or unknown etiology) (p=0.005), time to first BZD (p<0.001), and time to first non-BZD AED (p<0.001). However, the regression coefficient for etiology is considerably larger (structural vs. others: 35.82, SE: 12.45) compared to those for other predictors (time to first BZD: 0.72, SE: 0.03, and time to first non-BZD: 1.59, SE: 0.02). Hence, clinically the etiology would be the most important predictor of the duration of SE. AED choice (non-recommended versus recommended treatment strategy) (p=0.016) was not associated with SE duration (Table 2).Conclusions: The main determinants of convulsive SE duration in our series were structural etiology, time to first BZD, and time to first non-BZD AED, but not AED choice (non-recommended versus recommended treatment strategy) (This study was funded by an AES/Epilepsy Foundation of America infrastructure award).
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