A Study on Etiological Evaluation of Children Aged 2 Months-12 Years with status epilepticus Admitted in a Tertiary Care Centre.

Corresponding Author:
Saheli Dasgupta,
Vivekananda Institute of Medical Sciences,
#99 Sarat Bose Road,
Kolkata-700026, West Bengal, India.
E-mail: 1988saheli@gmail.com

ABSTRACT

BACKGROUND

Status epilepticus is a medical emergency requiring early and effective treatment. The most important cause of status epilepticus varies with age of the child. While febrile seizure with S.E. are the most common cause in children less than 5 years, infections and trauma are more common in older children. The important risk factors for status epilepticus are a history of epilepsy, younger age of the patient, genetic predisposition and acquired brain insult. Airway, respiratory, and circulatory support should be provided immediately. Initial investigations should then focus on possible metabolic derangements and conditions that require immediate treatment, such as meningitis. The recommended first-line therapy includes a fast-acting benzodiazepine followed by longer-acting antiepileptic. In cases of refractory status epilepticus, further treatment will depend on the setting. When paediatric intensive care is available, midazolam, barbiturates, and propofol are options. Neuroimaging by either CT or MRI should be undertaken only after the patient has been stabilized and the convulsive seizure activity controlled.

METHODS

The study was conducted among children aged 2 months to 12 years of age admitted to Vivekananda Institute of Medical Sciences, Kolkata for 1 year. Ethical clearance was obtained from the institute’s ethics committee before enrolment. Both newly diagnosed patients and known cases of seizure disorder presenting with status epilepticus were enrolled. 50 Children aged 2 months to 12 years presenting with status epilepticus were selected.

RESULTS

50 patients were studied. Mean age was 3.12 (Range 2 months-12 years). Male to female ratio is 1.3:1. 74% children had GTCS (generalized tonic clonic seizure), focal seizures were seen in 18% and non-convulsive status epilepticus was seen in 2%. The most common cause was found to be febrile seizure with status epilepticus which was 76%. 14% patients had structural lesions found in MRI. 4% cases were found to have ADEM (Acute Disseminated Encephalo-Myelitis). 6% cases were found to have diffuse slowing on EEG and 8 % showed bilateral epileptiform discharges on EEG.

CONCLUSIONS

Status epilepticus is a common neurological emergency in children. The mortality and morbidity associated with SE has decreased over the years due to a systematic approach and prompt management. Earlier, duration of status epilepticus was 30 minutes as per definition. Pathologically, however, hippocampal neurons begin to die after 30 minutes of sustained seizure activity. So, using operational definition of 5 mins., is helpful as it prevents brain damage. This was the reason for using the operational definition of 5 mins., in our study.

KEY WORDS

Status Epilepticus, Children, Aetiology