Prolonged Convulsive Status Epilepticus in Thai Children: Mortality Rate and its Predictors

Abstract

AbstractConvulsive status epilepticus (CSE) is the most common neurological emergency condition among children and is associated with significant mortality and morbidity. Yet, there are little data on this condition in the context of Thailand. To address this information gap, we studied children with prolonged CSE in a major regional referral hospital to measure the case–fatality rate and predictors for fatal outcomes. Infants and children at least 1 month of age diagnosed with prolonged CSE (by the International League Against Epilepsy [ILAE] 2015 criteria), from January 1, 2011 to June 30, 2012 at a large tertiary hospital in Northeast Thailand, were analyzed. Data were collected from the medical record on demographic, etiology, treatment, and clinical course. Clinical outcomes were determined prospectively at 1, 3, and 6 months following hospital discharge. Sixty patients with CSE (31 males, 29 females) of mean age 3.8 years were identified. Eighteen children (30.0%) had been previously diagnosed with epilepsy. Their CSE etiologies were acute symptomatic (48.3%), febrile (30.0%), remote symptomatic (10.0%), idiopathic (6.7%), and progressive symptomatic (5.0%). Overall mortality was 11.7% (short-term ≤ 30 days, 5%; long-term > 30 days, 6.7%). High overall mortality rate was associated with delays in initiating treatment (p < 0.05, adjusted odds ratio [OR]: 10.5; 95% confidence interval [CI]: 1.2–89.7) and prolonged seizure duration > 90 minutes (p < 0.05, adjusted OR: 21.9; 95% CI: 1.9–257.6). With a high mortality rate of 11.7% among children with CSE, initiating early treatment according to established guidelines is essential to avoid this outcome.