Source:Pediatric Neurology
Author(s): Saba Jafarpour, Ryan M. Hodgeman, Carolina De Marchi Capeletto, Mateus Torres Avelar de Lima, Kush Kapur, Robert C. Tasker, Tobias Loddenkemper
Background: Many pediatric patients presenting with status epilepticus do not have any history of seizures. Methods: We retrospectively studied clinical characteristics in patients aged 1 month to 21 years who presented during 6 consecutive years with convulsive status epilepticus and without a prior history of seizures. New-Onset Refractory Status Epilepticus (NORSE) was defined as status epilepticus refractory to two lines of treatment, without an identified cause in the first 48 hours. Results: Of 460 patients with status epilepticus, 79 (17.2%) presented with new-onset status epilepticus, including 4 (0.9%) with NORSE. Of those, 54.4% were female, and the median age was 3.5 years (IQR: 1.08-6.75). Median seizure duration was 20 minutes (IQR: 10-40). Etiology was unknown in 36.7%, symptomatic in 30.3%, provoked in 16.5%, and provoked with an existing symptomatic etiology in 16.5%. EEG was abnormal in 70.9% of the patients, while MRI was abnormal in 54.7%. Patients were followed for a median duration of 63 months (IQR: 21-97). The mortality rate was 3.8%. Of 55 patients who were developmentally normal at baseline, 29.1% had a significant cognitive impairment at last follow-up, and 20% had academic difficulties or behavioral problems. Patients with symptomatic etiology had greater odds of having cognitive and behavioral problems compared to the unknown etiology (OR=3.83, p=0.012), while there was no difference between the provoked and the unknown groups (OR=0.62, p=0.50). Conclusion: New-onset status epilepticus patients are at risk of recurrent seizures, recurrent status epilepticus, death, and subsequent cognitive/behavioral impairment. Specific monitoring and care interventions might be required in this high-risk population.
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