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(Abst. 2.205), 2017

Long-Term Outcomes in Previously Healthy Children after Refractory Status Epilepticus (the pSERG cohort)
Authors: Theodore A. Sheehan, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States; Marina Gaínza-Lein, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States, Universidad Austral de Chile, Valdivia, Chile.; Kevin Chapman, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States; Juan A. Piantino, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR, United States; Anne Anderson, Baylor College of Medicine, Texas Children's Hospital; Ravindra Arya, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; Jessica L. Carpenter, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.; William D. Gaillard, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.; Tracy A. Glauser, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; Joshua L. Goldstein, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Mohamad A. Mikati, Duke University Medical Center, Duke University, Durham, NC, United States; Anuranjita Nayak, Baylor College of Medicine. Houston, TX, United States.; Katrina Peariso, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; Iván Sánchez Fernández, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States;Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain; Robert C. Tasker, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States; Dmitry Tchapyjnikov, Duke University Medical Center, Duke University. Durham, NC, United States; Mark S. Wainwright, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Angus Wilfong, Barrow Neurological Institute, Phoenix Children’s Hospital, Phoenix, AZ, United States; Korwyn Williams, Barrow Neurological Institute, Phoenix Children’s Hospital, University of Arizona School of Medicine, Phoenix, AZ, United States; Tobias Loddenkemper, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, USA; and on behalf of Pediatric Status Epilepticus Research Group (pSERG), Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States
Content: Rationale: To identify predictors of long-term neurological outcome in previously healthy children who presented with refractory convulsive status epilepticus (RCSE). Methods: This multicenter prospective observational study included previously healthy pediatric patients who presented with RCSE from 2011-2016 and who had at least a year of follow-up period. Our primary outcome was the Pediatric Glasgow Outcome Scale – Extended (GOSE-P), including patients with good recovery (GOSE-P < 3) and moderate or severe disability (GOSE-P ≥3). For univariate analysis, we used Fisher’s Exact Test and Wilcoxon rank sum test. For multivariate analysis, we used a stepwise logistic regression model adding variables with a p value < 0.2. Results: Sixty-seven patients presented with RCSE and no prior neurological disease, and follow up data were available for 52/67 (78%) after at least one year of the index RSE episode. Forty-four (66%) patients had a GOSE-P evaluation at follow-up. Twenty-one (48%) had a GOSE-P < 3 and 23 (52.7%) a GOSE-P ≥3. Median (p25-p75) follow-up time was 3.5 (2.4 – 4.5) years, 23 (52%) were females, and median age was 3.3 (0.8 – 10.2) years. Etiologies during the RCSE hospitalization were structural [13 (30%)], infectious [7 (16%)], autoimmune [1 (2%)], genetic or metabolic [0 (0%)], other [3 (7%)], and unknown [20 (46%)]. While on follow-up etiologies were determined as structural [14 (3%)], genetic [2 (5%)], infectious [9 (21%)], autoimmune [4 (9%)], metabolic [0 (0%)], and unknown [17 (4%)].The median (p25-p75) RCSE duration was shorter in the GOSE-P < 3 than in the GOSE-P ≥3 group [120 (30-360) minutes versus 570 (120-8640) minutes; p=0.02]. Fewer patients received continuous infusions in the GOSE-P < 3 than in the GOSE-P ≥3 group [8 (38%) versus 20 (87%); p=0.001]. In univariate analysis, there was no association of good or poor outcome with etiology (p=0.2), unknown etiology (p=0.8), gender (p=0.4), age (p=0.6), or follow-up period (p=0.7) (Table 1). In multivariate analysis, after adjustment for potential confounders, the use of continuous infusions during RCSE remained significant (OR 14.57; 95%CI 2.54 – 83.73; p=0.003) (Table 1). Unprovoked seizures at follow-up were more frequent in the GOSE-P < 3 than in the GOSE-P ≥3 group [14 (61%) versus 6 (29%); p=0.04]. Conclusions: Previously healthy children who presented with RSE were more likely to have a moderate to poor outcome (GOSE-P ≥3) if they required continuous infusion treatment during hospitalization. While we cannot rule out confounding by indication, adjusted results demonstrate association between long-term outcomes and use of continuous infusions, which implores us to look into the pathophysiological significance of this observation. Funding: Supported by Pediatric Epilepsy Research Foundation and Epilepsy Research Fund
Figure 1