Predictors of refractory status epilepticus in pediatric convulsive status epilepticus

Background Status epilepticus (SE) is a neurologic emergency associated with significant morbidity and mortality. It has been defined as persistent or recurrent seizures due to a failure of seizure termination mechanisms. Approximately half of the SE episodes occur in patients with epilepsy whereas the other half is known as ‘de novo’or new-onset SE. Refractory status epilepticus (RSE) is defined as seizures that persist after the administration of the first and second lines of treatment of SE and it carries a high mortality rate, especially with inadequate or delayed treatment. So early prediction of RSE using readily assessable parameters would allow for individualized therapies at early stages. Aim To identify early RSE predictors in epileptic children with SE. Patients and methods An observational retrospective study carried out in the ICU at Mansoura University Children Hospital (MUCH). A total of 89 patients aged 1 month − 18 years were included and subjected to history taking, neurological examination, and review of medical records from the Integrated Hospital Information System. Results The study included 89 epileptic children with convulsive SE, median age was 6 years (interquartile range 2–10); among them, 41 (46.1%) had RSE with a median age of 7 years (interquartile range 3–10). A statistically significant higher proportion of using more than 2 antiepileptic drugs, associated cerebral palsy diagnosis, abnormal neurological exam, and higher seizure number (3 or more in the previous 6 months) in RSE versus SE. Conclusion In epileptic children with SE; associated cerebral palsy diagnosis, poor seizure control, the need for multiple antiepileptic drugs to achieve seizure control and abnormal neurological examination are risk factors for RSE.