Incidence and outcome of convulsive status epilepticus in Kenyan children: a cohort study

Abstract

SummaryBackgroundConvulsive status epilepticus (CSE) is the most common neurological emergency in childhood and is often associated with fever. In sub-Saharan Africa, the high incidence of febrile illnesses might influence the incidence and outcome of CSE. We aimed to provide data on the incidence, causes, and outcomes of childhood CSE in this region.MethodsBetween March, 2006, and June, 2006, we studied all children who had been admitted with CSE to a Kenyan rural district hospital in 2002 and 2003. Confirmed CSE had been observed directly; probable CSE was inferred from convulsions on arrival, requirement for phenobarbital or phenytoin, or coma with a recent history of seizures. We estimated the incidence with linked demographic surveillance, and risk factors for death and neurological sequelae were analysed by multivariable analysis.FindingsOf 388 episodes of CSE, 155 (40%) were confirmed CSE and 274 (71%) were caused by an infection. The incidence of confirmed CSE was 35 (95% CI 27–46) per 100 000 children per year overall, and was 52 (21–107) and 85 (62–114) per 100 000 per year in children aged 1–11 months and 12–59 months, respectively. The incidence of all CSE was 268 (188–371) and 227 (189–272) per 100 000 per year in these age-groups. 59 (15%) children died in hospital, 81 (21%) died during long-term follow-up, and 46 (12%) developed neurological sequelae. Mortality of children with confirmed CSE while in hospital was associated with bacterial meningitis (adjusted relative risk [RR]=2·6; 95% CI 1·4–4·9) and focal onset seizures (adjusted RR=2·4; 1·1–5·4), whereas neurological sequelae were associated with hypoglycaemia (adjusted RR=3·5; 1·8–7·1) and age less than 12 months (adjusted RR=2·5; 1·2–5·1).InterpretationPrevention of infections and appropriate early management of seizures might reduce the incidence and improve the outcome of CSE in children in sub-Saharan Africa.

Prevalence, Aetiology and Outcome of Status Epilepticus in Children with Convulsions at the Wesley Guild Hospital, Ilesa

“…The hospital-based cohort study carried out in Kenya reported a minimum incidence of 35/100,000/year in children between the ages of 0-13 year [16]. This is referred to as the minimum incidence since a proportion of the children with SE will die before reaching the hospital, and others will be treated in private hospitals [10,16]. The incidence of convulsive status epilepticus in London, UK, has been reported as 18-20 per 100,000 per year in children less than 16 years old [17].…”

“…A hospitalbased study involving 22 states in the United States of America 4 reported a prevalence of 0.083 percent. The incidence of SE in SubSahara Africa is higher and this may be due to the presence of malaria and other CNS infections, and late presentation in the hospital for treatment when children have fever or are convulsing [8,10,16].…”

“…The mortality in Sub-Saharan Africa is higher than in the resource-rich countries. This may be due to the delay in presenting to hospital, poor management of SE in hospital and the underlying aetiology, lack of infrastructure or transport may further delay presentation to the hospital [16,23,29]. There are limited facilities and staff to manage patients in many hospitals in Africa.…”

“…There are limited facilities and staff to manage patients in many hospitals in Africa. Status epilepticus was found to be independently associated with neurological deficit at discharge as well as with mortality in children with acute seizures [8] The morbidity and mortality associated with status epilepticus is much higher developing in developing and resource-poor countries than it is in developed countries [10,12,16,17,21,29].…”

“…The outcome of SE particularly in Africa could be improved through adequate malaria control, prevention of CNS infections especially meningitis, appropriate early management of seizures, education, development of appropriate guidelines, and provision of appropriate facilities and infrastructure [8,10,16].…”