TY - JOUR
T1 - Factors associated with long-term outcomes in pediatric refractory status epilepticus
AU - the Pediatric Status Epilepticus Research Group
AU - Gaínza-Lein, Marina
AU - Barcia Aguilar, Cristina
AU - Piantino, Juan
AU - Chapman, Kevin E.
AU - Sánchez Fernández, Iván
AU - Amengual-Gual, Marta
AU - Anderson, Anne
AU - Appavu, Brian
AU - Arya, Ravindra
AU - Brenton, James Nicholas
AU - Carpenter, Jessica L.
AU - Clark, Justice
AU - Farias-Moeller, Raquel
AU - Gaillard, William D.
AU - Glauser, Tracy A.
AU - Goldstein, Joshua L.
AU - Goodkin, Howard P.
AU - Huh, Linda
AU - Kahoud, Robert
AU - Kapur, Kush
AU - Lai, Yi Chen
AU - McDonough, Tiffani L.
AU - Mikati, Mohamad A.
AU - Morgan, Lindsey A.
AU - Nayak, Anuranjita
AU - Novotny, Edward
AU - Ostendorf, Adam P.
AU - Payne, Eric T.
AU - Peariso, Katrina
AU - Reece, Latania
AU - Riviello, James
AU - Sannagowdara, Kumar
AU - Sands, Tristan T.
AU - Sheehan, Theodore
AU - Tasker, Robert C.
AU - Tchapyjnikov, Dmitry
AU - Vasquez, Alejandra
AU - Wainwright, Mark S.
AU - Wilfong, Angus
AU - Williams, Korwyn
AU - Zhang, Bo
AU - Loddenkemper, Tobias
N1 - Publisher Copyright:
© 2021 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.
PY - 2021/9
Y1 - 2021/9
N2 - Objective: This study was undertaken to describe long-term clinical and developmental outcomes in pediatric refractory status epilepticus (RSE) and identify factors associated with new neurological deficits after RSE. Methods: We performed retrospective analyses of prospectively collected observational data from June 2011 to March 2020 on pediatric patients with RSE. We analyzed clinical outcomes from at least 30 days after RSE and, in a subanalysis, we assessed developmental outcomes and evaluated risk factors in previously normally developed patients. Results: Follow-up data on outcomes were available in 276 patients (56.5% males). The median (interquartile range [IQR]) follow-up duration was 1.6 (.9–2.7) years. The in-hospital mortality rate was 4% (16/403 patients), and 15 (5.4%) patients had died after hospital discharge. One hundred sixty-six (62.9%) patients had subsequent unprovoked seizures, and 44 (16.9%) patients had a repeated RSE episode. Among 116 patients with normal development before RSE, 42 of 107 (39.3%) patients with available data had new neurological deficits (cognitive, behavioral, or motor). Patients with new deficits had longer median (IQR) electroclinical RSE duration than patients without new deficits (10.3 [2.1–134.5] h vs. 4 [1.6–16] h, p =.011, adjusted odds ratio = 1.003, 95% confidence interval = 1.0008–1.0069, p =.027). The proportion of patients with an unfavorable functional outcome (Glasgow Outcome Scale-Extended score ≥ 4) was 22 of 90 (24.4%), and they were more likely to have received a continuous infusion. Significance: About one third of patients without prior epilepsy developed recurrent unprovoked seizures after the RSE episode. In previously normally developing patients, 39% presented with new deficits during follow-up, with longer electroclinical RSE duration as a predictor.
AB - Objective: This study was undertaken to describe long-term clinical and developmental outcomes in pediatric refractory status epilepticus (RSE) and identify factors associated with new neurological deficits after RSE. Methods: We performed retrospective analyses of prospectively collected observational data from June 2011 to March 2020 on pediatric patients with RSE. We analyzed clinical outcomes from at least 30 days after RSE and, in a subanalysis, we assessed developmental outcomes and evaluated risk factors in previously normally developed patients. Results: Follow-up data on outcomes were available in 276 patients (56.5% males). The median (interquartile range [IQR]) follow-up duration was 1.6 (.9–2.7) years. The in-hospital mortality rate was 4% (16/403 patients), and 15 (5.4%) patients had died after hospital discharge. One hundred sixty-six (62.9%) patients had subsequent unprovoked seizures, and 44 (16.9%) patients had a repeated RSE episode. Among 116 patients with normal development before RSE, 42 of 107 (39.3%) patients with available data had new neurological deficits (cognitive, behavioral, or motor). Patients with new deficits had longer median (IQR) electroclinical RSE duration than patients without new deficits (10.3 [2.1–134.5] h vs. 4 [1.6–16] h, p =.011, adjusted odds ratio = 1.003, 95% confidence interval = 1.0008–1.0069, p =.027). The proportion of patients with an unfavorable functional outcome (Glasgow Outcome Scale-Extended score ≥ 4) was 22 of 90 (24.4%), and they were more likely to have received a continuous infusion. Significance: About one third of patients without prior epilepsy developed recurrent unprovoked seizures after the RSE episode. In previously normally developing patients, 39% presented with new deficits during follow-up, with longer electroclinical RSE duration as a predictor.
KW - clinical neurology
KW - epilepsy
KW - outcome research
KW - pediatric
KW - status epilepticus
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U2 - 10.1111/epi.16984
DO - 10.1111/epi.16984
M3 - Article
C2 - 34251039
AN - SCOPUS:85109743250
SN - 0013-9580
VL - 62
SP - 2190
EP - 2204
JO - Epilepsia
JF - Epilepsia
IS - 9
ER -