Early Clinical Variables Associated With Refractory Convulsive Status Epilepticus in Children
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Abstract
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 p < 0.1 were retained for univariable and multivariable regression analyses. Multivariable logistic regression models were fit to age-matched and sex-matched data to obtain variables associated with RSE.
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], p = 0.068). Time to second-line ASM was shorter in patients with RSE (RSE 65 minutes; rESE 70 minutes; p = 0.021). Both univariable and multivariable regression analyses revealed a family history of seizures (OR 0.37; 95% CI 0.20–0.70, p = 0.0022) or a prescription for rectal diazepam (OR 0.21; 95% CI 0.078–0.53, p = 0.0012) was associated with decreased odds of RSE.
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.
Glossary
- ASM=
- antiseizure medication;
- BZD=
- benzodiazepine;
- ESETT=
- Established SE Treatment Trial;
- IQR=
- interquartile range;
- pSERG=
- Previous work from the pediatric SE Research Group;
- rESE=
- responsive established SE;
- RSE=
- refractory SE;
- SE=
- status epilepticus
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigators are listed at links.lww.com/WNL/C888.
Submitted and externally peer reviewed. The handling editor was Associate Editor Courtney Wusthoff, MD, MS.
Class of Evidence: NPub.org/coe
- Received March 17, 2022.
- Accepted in final form April 17, 2023.
- © 2023 American Academy of Neurology
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