Convulsive status epilepticus in a quaternary hospital paediatric intensive care unit (PICU) in South Africa: An 8 year review

Reddy, Yavini; Balakrishna, Yusentha; Mubaiwa, L

doi:10.1016/j.seizure.2017.07.016

Cited by 14 publications

(11 citation statements)

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“…38 patients had seizures lasting for 60 mins to 24 h and 7 patients for more than 24 h. This is because patients from remote rural areas are referred to our hospital for management of SE and at times, poor transportation facilities lead to a delay in initiation of treatment. Seizure characteristics such as duration, number of drugs needed to achieve control and presence of recurrent seizures had an association with outcome as seen in multiple studies [ 12 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review [ 18 ] reported that 1% to 12% of children from countries in the developed world presenting with SE have infectious cause as compared to 28.6% seen in our study. An 8-year review of PICU admissions in a hospital in South Africa [ 17 ] showed an infective cause in 43% cases, whereas an Indian study conducted in Bihar [ 16 ] showed 38.5% cases. Thus, infections are still a major cause of pediatric SE in developing countries like India and the scope of preventive strategies in reducing its burden is large.…”

Section: Discussionmentioning

confidence: 99%

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A study of critically ill children presenting with seizures regardless of seizure duration admitted in the PICU of a tertiary hospital in India

Amonkar¹,

Revathi²,

Gavhane³

2020

Epilepsy & Behavior Reports

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Our aim was to study the clinical profile, immediate outcome and risk factors associated with poor outcome in critically ill children presenting with seizures requiring PICU admission. As seizures lasting 10 min or more can potentially cause brain damage, we included all children regardless of seizure duration. The records of 157 children aged 1 month to 16 years admitted in the PICU at a tertiary hospital in India with seizures as the presenting symptom during a three-year period were studied retrospectively. Median age of patients was 4 years. 34 (21%) had pre-existing epilepsy and 33 (21%) had previous developmental delay/neuro-deficit. Seizure duration was > 30 min in 75 (47.7%) and 56 (35.6%) required the use of more than 2 antiseizure drugs. 101 (64%) had acute symptomatic seizures, 28 (17%) remote symptomatic and 27 (17.1%) had unknown cause. New onset neurological deficit was seen in 18 (15.6%) and 14 (8.9%) died. Young age, high PEWS score at presentation, prolonged/recurrent seizures, CNS infection, need for multiple antiseizure drugs and ventilation/pressor use were risk factors for poor outcome. Neurological outcome and survival of children in our study were good. Further all-inclusive studies irrespective of seizure duration are needed to obtain a complete picture of critical children presenting with seizures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A study of critically ill children presenting with seizures regardless of seizure duration admitted in the PICU of a tertiary hospital in India

Amonkar¹,

Revathi²,

Gavhane³

2020

Epilepsy & Behavior Reports

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“…Within the acute symptomatic etiology, CNS infections (e.g. herpes simplex virus (HSV), HIV, neurocysticercosis, malaria, tuberculosis), viral/autoimmune encephalitis and meningitis are common causes [7,[24][25][26][27][28][29][30].…”

Section: Etiologymentioning

confidence: 99%

Pediatric refractory and super-refractory status epilepticus

Vasquez

Farias‐Moeller

Tatum

2019

Seizure

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“…The incidence of CSE is the highest among children and the elderly [9,10,11]. Of importance, over 80.0% of children with epilepsy are located in resource-limited countries [12] and CSE is the second most common outpatient neuropsychiatric diagnosis in Mozambique [13]. Even though CSE is a worldwide problem, optimal care is hampered by multiple barriers in resource-limited countries.…”

Section: Introductionmentioning

confidence: 99%

“…These barriers include the unavailability of ASMs, patient transportation delays, low quality health care infrastructures and the potential lack of a CSE treatment protocol [6,14,15]. Especially in resource-limited countries, the lack of clear treatment strategies (prehospital and hospital management) could induce unnecessary treatment delays, extra morbidities and higher mortality rates [12,16].…”

Section: Introductionmentioning

confidence: 99%

Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

Sourbron

Lagae

Sulemane

2021

JICNA

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Background: Optimal care of Convulsive status epilepticus (CSE) can be related to multiple barriers in resource-limited countries. Objectives and methods: Since limited data of CSE management are available from South-East Africa, we performed a retrospective analysis of the electronic records of pediatric patients with CSE admitted to the Maputo Central hospital from January 2016 until April 2019. Results: Our database consisted out of 39 patients. The average age was 5.15 (range 0.3-13.8) years and demographic characteristics did not show a relation to CSE characteristics or outcomes. However, the total stay in the hospital was negatively correlated with age (p=0.0314). Moreover, 14 patients needed to be admitted to the IC, which was correlated to having generalized motor seizures (p=0.0253), and a relatively higher need for a second AED to control their CSE (p=0.0131). Regarding AED use, the first AED was a IV benzodiazepine (BZD: midazolam (MIDA) or diazepam (DIAZ)) or IV phenytoin (PHEN) when BZDs were not available. There was no statistically significant difference between the efficacy of MIDA vs. DIAZ. Eleven patients received PHEN as a second-line drug, of which only two patients needed an additional dose of PHEN. None of the patients died and five patients (13.2%) had an extra comorbidity after CSE. Conclusions: Although limited AEDs were available in our study, compared to more AEDs in other developing and developed countries, we report the successful cessation of CSE in the majority of cases. We recommend strategies to improve prehospital management such as the use of non-IV BZD use, to limit the need for patients to be admitted to the IC and thereby potentially decreasing the number of AEDs, morbidity and hospital duration. Moreover, our data underline the conversion to second-line AEDs (PHEN) to be adequate in nearly all patients.

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Convulsive status epilepticus in a quaternary hospital paediatric intensive care unit (PICU) in South Africa: An 8 year review

Abstract: The high burden of infection related CSE is associated with high morbidity and mortality rates in contrast to the rates in developed countries. This highlights the need for early recognition and treatment of underlying conditions.

Cited by 14 publications

References 14 publications

A study of critically ill children presenting with seizures regardless of seizure duration admitted in the PICU of a tertiary hospital in India

A study of critically ill children presenting with seizures regardless of seizure duration admitted in the PICU of a tertiary hospital in India

Pediatric refractory and super-refractory status epilepticus

Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

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