Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Iván Sánchez Fernández, Michele C. Jackson, Nicholas S. Abend, Ravindra Arya, James N. Brenton, Jessica L. Carpenter, Kevin E. Chapman, William D. Gaillard, Marina Gaínza-Lein, Tracy A. Glauser, Joshua L Goldstein, Howard P. Goodkin, Ashley Helseth, Kush Kapur, Tiffani Leigh McDonough, Mohamad A. Mikati, Katrina Peariso, James Riviello, Robert C. Tasker, Alexis A. TopjianMark Wainwright, Angus Wilfong, Korwyn Williams, Tobias Loddenkemper*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Objective: To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE). Methods: This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE. Results: We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.2 (1.3-9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [5-60] vs 16.5 [5-42.75] minutes, p = 0.858). Patients with a diagnosis of epilepsy received their first non-benzodiazepine (BZD) antiepileptic drug (AED) later (93 [46-190] vs 50.5 [28-116] minutes, p = 0.002) and were less likely to receive at least one continuous infusion (35/89 [39.3%] vs 57/100 [57%], p = 0.03). Compared to patients with no history of SE, patients with a history of SE received their first BZD earlier (8 [3.5-22.3] vs 20 [5-60] minutes, p = 0.0073), although they had a similar time to first non-BZD AED (76.5 [45.3-124] vs 65 [32.5-156] minutes, p = 0.749). Differences were mostly driven by the patients with an out-of-hospital rSE onset. Conclusions: Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication.

Original languageEnglish (US)
Pages (from-to)386-394
Number of pages9
JournalNeurology
Volume88
Issue number4
DOIs
StatePublished - Jan 24 2017

ASJC Scopus subject areas

  • Clinical Neurology

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