Recurrent status epilepticus in children

Authors

  • Dr Shlomo Shinnar MD, PhD,

    Corresponding author
    1. Departments of Neurology, the Albert Einstein College of Medicine, Bronx
    2. Departments of Pediatrics, the Albert Einstein College of Medicine, Bronx
    3. Montefiore/Einstein Epilepsy Management Center, Bronx
    • Division of Pediatric Neurology, VCP-207, Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467
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  • Joseph Maytal MD,

    1. Departments of Neurology, the Albert Einstein College of Medicine, Bronx
    2. Departments of Pediatrics, the Albert Einstein College of Medicine, Bronx
    3. Division of Pediatric Neurology, Schneider Children's Hospital, Long Island Jewish Medical Center, Queens, NY
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  • Lawrence Krasnoff PhD,

    1. Montefiore/Einstein Department of Biostatistics, Montefiore Medical Center, Bronx
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  • Solomon L. Moshe MD

    1. Departments of Neurology, the Albert Einstein College of Medicine, Bronx
    2. Departments of Pediatrics, the Albert Einstein College of Medicine, Bronx
    3. Departments of Neuroscience, the Albert Einstein College of Medicine, Bronx
    4. Montefiore/Einstein Epilepsy Management Center, Bronx
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Abstract

Status epilepticus is an uncommon but life-threatening seizure. Little is known about the risk of recurrent status epilepticus in patients who present with an initial episode. To determine the risk of recurrent status epilepticus in children, we prospectively followed 95 children, identified at the time of their first episode of status epilepticus, for a mean of 29.0 months (range, 4–60 months). The patients' ages ranged from 1 month to 18 years (mean, 4.6 years). The cause of the status epilepticus was classified as idiopathic (n = 24), remote symptomatic (n = 18), febrile (n = 29), acute symptomatic (n = 18), or progressive neurological disorder (n = 6). Sixteen children (17%) had at least 2 episodes of status epilepticus. The risk of recurrent status was 4% (n = 1) in the idiopathic group, 44% (n = 8) in the remote symptomatic group, 3% (n = 1) in the febrile group, 11% (n = 2) in the acute symptomatic group, and 67% (n = 4) in those with progressive neurological disease. Recurrent status epilepticus occurred primarily in neurologically abnormal children. While neurologically abnormal children accounted for 34% (n = 32) of all children with status epilepticus, they comprised 88% (n = 14) of the children with recurrent status epilepticus (p < 0.001) and all 5 of the children with multiple (≥ 3) episodes of status (p < 0.001). Fifteen of 16 children with recurrent status epilepticus were being treated with antiepileptic drugs at the time of recurrence. The morbidity and mortality of status epilepticus were low. No child had a measurable deterioration in neurological function following a subsequent episode of status epilepticus. Recurrent status epilepticus occurs primarily in children with an underlying neurological abnormality. Status epilepticus reoccurs in this group despite conventional antiepileptic drug therapy.

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