Early Clinical Variables Associated With Refractory Convulsive Status Epilepticus in Children.
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
01 08 2023
01 08 2023
Historique:
received:
17
03
2022
accepted:
17
04
2023
pmc-release:
01
08
2024
medline:
2
8
2023
pubmed:
10
6
2023
entrez:
9
6
2023
Statut:
ppublish
Résumé
The objective of this study was to determine patient-specific factors known proximate to the presentation to emergency care associated with the development of refractory convulsive status epilepticus (RSE) in children. An observational case-control study was conducted comparing pediatric patients (1 month-21 years) with convulsive SE whose seizures stopped after benzodiazepine (BZD) and a single second-line antiseizure medication (ASM) (responsive established status epilepticus [rESE]) with patients requiring more than a BZD and a single second-line ASM to stop their seizures (RSE). These subpopulations were obtained from the pediatric Status Epilepticus Research Group study cohort. We explored clinical variables that could be acquired early after presentation to emergency medical services with univariate analysis of the raw data. Variables with We compared data from a total of 595 episodes of pediatric SE. Univariate analysis demonstrated no differences in time to the first BZD (RSE 16 minutes [IQR 5-45]; rESE 18 minutes [IQR 6-44], Time to initial BZD or second-line ASM was not associated with progression to RSE in our cohort of patients with rESE. A family history of seizures and a prescription for rectal diazepam were associated with a decreased likelihood of progression to RSE. Early attainment of these variables may help care for pediatric rESE in a more patient-tailored manner. This study provides Class II evidence that patient and clinical factors may predict RSE in children with convulsive seizures.
Sections du résumé
BACKGROUND AND OBJECTIVES
The objective of this study was to determine patient-specific factors known proximate to the presentation to emergency care associated with the development of refractory convulsive status epilepticus (RSE) in children.
METHODS
An observational case-control study was conducted comparing pediatric patients (1 month-21 years) with convulsive SE whose seizures stopped after benzodiazepine (BZD) and a single second-line antiseizure medication (ASM) (responsive established status epilepticus [rESE]) with patients requiring more than a BZD and a single second-line ASM to stop their seizures (RSE). These subpopulations were obtained from the pediatric Status Epilepticus Research Group study cohort. We explored clinical variables that could be acquired early after presentation to emergency medical services with univariate analysis of the raw data. Variables with
RESULTS
We compared data from a total of 595 episodes of pediatric SE. Univariate analysis demonstrated no differences in time to the first BZD (RSE 16 minutes [IQR 5-45]; rESE 18 minutes [IQR 6-44],
DISCUSSION
Time to initial BZD or second-line ASM was not associated with progression to RSE in our cohort of patients with rESE. A family history of seizures and a prescription for rectal diazepam were associated with a decreased likelihood of progression to RSE. Early attainment of these variables may help care for pediatric rESE in a more patient-tailored manner.
CLASSIFICATION OF EVIDENCE
This study provides Class II evidence that patient and clinical factors may predict RSE in children with convulsive seizures.
Identifiants
pubmed: 37295955
pii: WNL.0000000000207472
doi: 10.1212/WNL.0000000000207472
pmc: PMC10401687
doi:
Substances chimiques
Anticonvulsants
0
Benzodiazepines
12794-10-4
Diazepam
Q3JTX2Q7TU
Types de publication
Observational Study
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e546-e557Subventions
Organisme : NINDS NIH HHS
ID : R01 NS115929
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS045911
Pays : United States
Organisme : NINDS NIH HHS
ID : U10 NS077311
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS053998
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS062756
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS043209
Pays : United States
Organisme : NLM NIH HHS
ID : R01 LM011124
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS065840
Pays : United States
Organisme : NINDS NIH HHS
ID : U24 NS107200
Pays : United States
Organisme : NCATS NIH HHS
ID : U01 TR002623
Pays : United States
Organisme : NINDS NIH HHS
ID : K02 NS096058
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS116225
Pays : United States
Investigateurs
Seema Bansal
(S)
Christa Habela
(C)
Dalila Lewis
(D)
Claudine Sculier
(C)
Melissa Sacco
(M)
Daniel Santel
(D)
Amanda Weber
(A)
Asri Yuliati
(A)
Azara Singh
(A)
Ashley Heath
(A)
David Turner
(D)
Cecilia Fernandes
(C)
Linh Tran
(L)
Raquel Farias-Moeller
(R)
Kurt Hecox
(K)
Kumar Sannagowdara
(K)
David Goldstein
(D)
Erin Heinzen Cox
(EH)
Colin Malone
(C)
Alexis Topjian
(A)
Cecil Hahn
(C)
Saptharishi Rishi Lalgudi Ganesan
(SRL)
Steven Weinstein
(S)
Nathan Dean
(N)
Renee Shellhaas
(R)
Guilia Benedetti
(G)
Garnett Smith
(G)
Olga Selioutski
(O)
Inna Hughes
(I)
Lurie Seltzer
(L)
Informations de copyright
© 2023 American Academy of Neurology.
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