Clinical profile and outcome of children admitted with status epileptics in PICU of a developing country

ABSTRACT

Status epilepticus [SE] is a common, life-threatening neurologic disorder. The exact incidence is not known. The frequency of occurrence of status epilepticus is 17-23 per 100, 000 persons per year, with the higher incidences occurring in developing countries. In children the mortality from SE ranges from 3-10%. To describe the etiology, clinical profile and immediate-outcome of children with status epilepticus at a Tertiary Care Hospital in Karachi. This is a descriptive and retrospective cohort study on all children admitted in our institution with diagnosis of status epileptics [ICD 9 code 3453]. Demographic, pertinent clinical variables and outcomes were collected on structured questionnaire. During the study period, fifty patients were identified. Mean age was 51 months [age range was 1-168 months with SD +/- 41 months]. There were 29 male and 21 female. Generalized tonic clonic seizures were the most common [86%] form of seizures observed. Twenty- five [50%] patients were newly diagnosed with no prior history of seizure. Acute febrile illness or infections were the most common etiology [52%]. No biochemical abnormalities were observed in our study. Abnormal EEG was reported in 62% of patients. CSF abnormalities were observed in 22%. Minimum 2 and maximum 8 anti-epileptic drugs were used [mean= 4.33]. The most commonly parenteral drugs included phenytoin, phenobarbitone, levetiracetam and valproic acid. Thirty- one [62%] patients required continuous midazolam infusion. In majority [44%], status was controlled after more than 60mins. Thirty-three patients [66%] required PICU admission for seizure control. Thirty one [62%] required mechanical ventilation, twenty five [50%] required inotropic support. Mean PICU stay duration was 3.89 days [range=1-15 days]. Survival rate was 92%. The cause of death [n=4] was related to underlying systemic illness. No complications were observed in forty-one [82%] patients. In our report, young children had a high incidence of SE and the most common etiology was acute febrile illness. Majority of cases were refractory SE although the mortality rate was low