Epileptic Status in a PEDiatric cohort (ESPED) requiring intensive care treatment: A multicenter, national, two‐year prospective surveillance study

Abstract

Objective:The aim of this study was to provide seizure etiology, semiology, underlying conditions, and out-of-and in-hospital diagnostics, treatment, and outcome data on children with out-of-or in-hospital-onset status epilepticus (SE) according to the International League Against Epilepsy definition that required admission to the pediatric intensive care unit (PICU) for ≥4 hours. Methods: This prospective national surveillance study on SE in childhood and adolescence was conducted over 2 years (07/2019-06/2021). Results: This study examined 481 SE episodes in 481 children with a median age of 43 months (1 month to 17 years 11 months), of which 46.2% were female and 50.7% had a previous seizure history. The most frequent acute SE cause was a prolonged, complicated febrile seizure (20.6%). The most common initial seizure types were generalized seizures (49.9%), focal seizures (18.0%), and unknown types (12.1%); 40.5% of patients suffered from refractory SE and 5.0% from superrefractory SE. The three most common medications administered by nonmedically trained individuals were diazepam, midazolam, and antipyretics. The three most frequent anti-seizure medications (ASMs) administered by the emergency physician were midazolam, diazepam, and propofol. The three most common ASMs used in the clinical setting were midazolam, levetiracetam, and phenobarbital. New ASMs administered included lacosamide, brivaracetam, perampanel, stiripentol, and eslicarbazepine. Status epilepticus terminated in 16.0% in the preclinical setting, 19.1% in the emergency department, and 58.0% in the PICU;the outcome was unknown for 6.9%. The median PICU stay length was 2 (1-121) days. The median modified Rankin scale was 1 (0-5) on admission and 2 (0-6) at discharge. New neurological deficits after SE were observed in 6.2%. The mortality rate was 3.5%.

Aetiology and Outcome of Childhood Convulsive Status Epilepticus

“…Furthermore, neurological disability was categorized into mild (Rankin score of 2), moderate (Rankin score of 3), and severe disability (Rankin scores of 4-5). [17][18] To determine the outcomes of previously neurologically disabled children, the study also considered the baseline Glasgow Coma Scale with a modified Rankin score.…”

Epilepsiechirurgie beim therapierefraktären Status epilepticus des Kindesalters

“…In two institutional series of 750 and 391 operated pediatric patients with epilepsy, only 15 and 10 patients (2.0 and 2.6%, respectively) underwent epilepsy surgery to treat RSE [10,11]. By contrast, a recent nationwide report in Germany reported not a single surgical case in a total cohort of 483 RSE patients [12].…”