ICNC Abstracts, ICNC 2018

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Super Refractory Status Epilepticus in children : Etiological, electrophysiological, treatment and outcome profile
Deepti Ashok Kewalramani, Sonam Kothari, Shilpa Kulkarni, Anaita Hegde, Krishankumar Shah

Last modified: 2018-09-09

Abstract


INTRODUCTION: Super Refractory Status Epilepticus (SRSE) is defined as continuous or recurrent seizures without normalization of consciousness lasting for 24 hours or more despite administration of intravenous (IV) anesthetic agent or recurrence of status epilepticus(SE) on weaning of IV anesthetics. Comprehensive literature of SRSE is scarce. The current studyaims to assess etiological and outcome profile of SRSE in children. METHODOLOGY: A retrospective review of the clinical, etiological,electrophysiological (EEG) and outcome profile of children with SRSE over a period of two years (2016-2018) was done. RESULTS: A total of 15 children (M:F=2:3) in the age range of 3months to 16 years (median-8years) were diagnosed with SRSE.The seizures were grouped into generalized tonic clonic seizures (n=5), focal (n=3),focal with secondary generalization (n=7). 7/15 patients had Febrile Infection-Related Epilepsy Syndrome (FIRES). Autoimmune encephalitis was seen in 3/15. 2/15 had viral encephalitis, 2/15 had metabolic etiology and 1 had cortical malformation.The mean duration of Intensive Care Unit stay was 19 days (±14.71 days). The mean follow-up duration was 11 months (± 8 months).The outcome was assessed using Glasgow Outcome Scale-extended and grouped into good recovery (n=6), moderate disability (n=1), severe disability (n=3), vegetative state (n=0) and death (n=5). 3/15 (20%) had seizure control on midazolam infusion, while others required addition of another anesthetic infusion and ketogenic diet. Patientswith FIRES had worst prognosis. Children with focal abnormalities on EEG had a better outcome. CONCLUSION: Aggressive initial treatment modalities result in better response and may improve outcomes.



Keywords


Super Refractory Status Epilepticus, Febrile Infectiion-Related EpilepsySyndrome, Autoimmune encephalitis, Glasgow Outcome Scale-extended

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