Early Clinical Variables Associated With Refractory Convulsive Status Epilepticus in Children

Katrina Peariso, Division of Neurology and Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, Cincinnati, OH, USA peariska@ucmail.uc.edu.
Ravindra Arya, Division of Pediatric Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Tracy Glauser, Division of Pediatric Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Nicholas S. Abend, Division of Neurology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Cristina Barcia Aguilar, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Marta Amengual-Gual, Department of Child Neurology, Hospital Universitario La Paz, Universidad Autonoma de Madrid, Madrid, Spain.
Anne Anderson, Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Brian L. Appavu, Department of Pediatrics, University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.
J Nicholas Brenton, Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, VA, USA.
Jessica Carpenter, Division of Pediatric Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
Kevin E. Chapman, Department of Pediatrics, University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.
Justice Clark, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
William D. Gaillard, Center for Neuroscience, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Marina Gaínza-Lein, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Joshua Goldstein, Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Howard Goodkin, Department of Neurology and Pediatrics, University of Virginia Health System, Charlottesville, VA, USA.
Zachary Grinspan, Division of Pediatric Neurology and Epilepsy, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
Rejean M. Guerriero, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis, MO, USA.
Paul S. Horn, Division of Pediatric Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Linda Huh, Department of Pediatrics, British Columbia Children's Hospital, the University of British Columbia, BC Canada.
Robert Kahoud, Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Sarah A. Kelley, Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Eric H. Kossoff, Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Kush Kapur, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Yi-Chen Lai, Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
B Oyinkan Marquis, Division of Pediatric Neurology and Epilepsy, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA.
Tiffani McDonough, Department of Pediatrics, Division of Neurology and Epilepsy, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Mohamad A. Mikati, Division of Pediatric Neurology, Duke University Medical Center, Duke University, Durham, NC, USA.
Lindsey Morgan, Department of Neurology, Division of Child Neurology, Seattle Children's Hospital, Seattle, WA, USA.
Edward Novotny, Department of Neurology, Division of Child Neurology, Seattle Children's Hospital, Seattle, WA, USA.
Adam P. Ostendorf, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
Eric T. Payne, Division of Neurology, Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada.

Document Type

Journal Article

Publication Date

6-9-2023

Journal

Neurology

Abstract

OBJECTIVE: 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 benzodiazepines (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 sub-populations were obtained from the pediatric Status Epilepticus Research Group (pSERG) 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 analysis. Multivariable logistic regression models were fit to age 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 min (IQR 5-45); rESE 18 min (IQR 6-44), p=0.068). Time to second-line ASM was shorter in RSE patients (RSE 65 min; rESE 70 min; p=0.021). Both univariable and multivariable regression analysis 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) were associated with decreased odds of RSE. CONCLUSIONS: 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. COE: This study provides class II evidence that patient and clinical factors may predict RSE in children with convulsive seizures.

Department

Neurology

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