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(Abst. 3.403), 2017

Distinguishing Pediatric Patients with Status Epilepticus and Refractory Status Epilepticus: A Case-Control Study
Authors: Katrina Peariso, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; Ravindra Arya, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; Tracy A. Glauser, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; Marina Gaínza-Lein, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States, Universidad Austral de Chile, Valdivia, Chile.; 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; Nicholas S. Abend, The Children’s Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania. Philadelphia, PA, United States; J. Nicholas Brenton, University of Virginia Health System, Charlottesville, VA, 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.; Joshua L. Goldstein, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Howard P. Goodkin, University of Virginia Health System, Charlottesville, VA, United States; Kush Kapur, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States; Tiffani L. McDonough, Columbia University Medical Center, Columbia University. New York, NY, United States.; Mohamad A. Mikati, Duke University Medical Center, Duke University, Durham, NC, United States; Eric Payne, Mayo Clinic, Rochester, Minnesota, United States; Juan A. Piantino, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR, United States; James Riviello, Columbia University Medical Center, Columbia University, New York City, NY, United States.; 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; Korwyn Williams, Barrow Neurological Institute, Phoenix Children’s Hospital, University of Arizona School of Medicine, Phoenix, AZ, United States; and Tobias Loddenkemper, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, USA
Content: Rationale: Objective:  Determine both modifiable and non-modifiable variables in pediatric patients with status epilepticus (SE) that may predict the risk for developing refractory convulsive status epilepticus (RSE), compared with a control SE group. Methods: Data from June 2011-April 2017 were abstracted fromthe multicenter collaborative study, the Pediatric Status Epilepticus Research Group (pSERG).  Demographic and standardized clinical variables were used to assess unique risk factors for the development of RSE.  Patients were included in the RSE group if they were between one month and 21 years of age and required more than a benzodiazepine (BZD) and ≥2 non-BZD anti-seizure medications (ASM) or a continuous infusion of an anesthetic to manage their RSE.  Patients of the same age as above were enrolled in the control SE group if they required no more than a BZD and a single ASM to abort their SE. Variables were examined for consistency and distributional properties. Categorical and continuous variables were compared between groups of patients with SE and RSE, using Fisher’s exact test and t-test for independent samples, respectively. Univariate logistic regressions were performed with type of SE (controlled vs. refractory) as the dependent variable. Results: For patients with RSE compared to SE, there were no significant differences in the age of presentation, gender, race, percentages of patients prescribed home rescue medication, or those that were currently on an anti-epileptic drug (AED) (Table 1).  Also, there were no significant differences in the time to initial BZD or first non-BZD ASM between both groups.  Clinically significant hypotension, intubation and overall seizure duration were more prevalent and of longer duration in the RSE group. Of note, having a family history of seizure(s), a variable that could be discerned from patient guardians by emergency providers, correlates with having seizures that were responsive to fewer medications on presentation (Table 1).  At initial follow-up after hospital discharge, patients with RSE were treated with higher numbers of AEDs than patients with SE (2.5 vs 2, p=0.01). Conclusions: This study found no differences in modifiable treatment factors between children with RSE versus those with SE.  However, obtaining a family history may help determine which patients could require more aggressive escalation of treatment.  The reason for a decreased likelihood of RSE in patients with a family history of seizures remains unclear.  In families with several members with seizures, caregivers may be more accustomed to recognizing seizure onset, which could bias the time to presentation to medical care and medication administration.  Alternatively, genetic epilepsies and febrile seizures could be more responsive to current medication regimens than symptomatic status epilepticus.  Follow-up studies are in progress. Funding: Pediatric Epilepsy Research Foundation, Epilepsy Research Fund
Figure 1