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• W2894327984 abstract "INTRODUCTION: Status Epilepticus (SE) is one of the most critical medical emergenciesthat may result in significant morbidity and mortality if not addressed in atimely and effective manner1. The approach in generalized convulsive SE ismodified by changing concepts regard the definition of SE and studiesjustifying more aggressive treatment, with earlier intervention started prior toarrival to hospital. Currently SE has 1/5 the morbidity and 1/3 the mortality ofpre -19702. But still mortality is around 11-53% 3, 4, 5. Improvements reflectstudies, retrospective data, changing definition of SE (from >60 minutes to > 5minutes). But most important factor is improved care. Although most seizuresin children stop prior to arrival at a hospital, an estimated 60,000 US childrenare treated each year for SE. 1/3 of the episodes will be initial event in a patientwith new onset epilepsy and an additional third occur in children withestablished epilepsy. Up to 70% of children with epilepsy beginning before age1 will experience as episode of SE in their life time. Incidence is about 50000-2.5 Lakhs times/year in US. 21% were <1year and 64% were <5 years. <50%of SE has h/o epilepsy. 15% of the epileptics will have SE at one time. 10% ofthe epileptics will present with SE at I time itself. IMPORTANT CAUSES: Acute causes:CNS infections, febrile convulsions, trauma, metabolicderangements, toxins, drugs overdose, vascular, hypoxia etc. Static causes:Idiopathic epilepsy (here SE may be the first manifestation or may beprecipitated by drug default /poor compliance, irregular drugs sudden withdrawal of AED, change of drugs, inadequate AED level in serum, fever,stress, sleep deprivation), structural brain lesions either developmental oracquired. Progressive causes: Degenerative cerebral disorders. AIM OF THE SYUDY: Aim of this study is to determine clinical profile, and immediateoutcome of SE in children, managed in our hospital.Secondary aim is to identify risk factors influenzing adverse outcome. DISCUSSION: 1. Hypoglycemia at arrival was noted in 13 children and hyperglycemiain 11 cases. Hypoglycemia may be the cause of SE or consequence.None of the children responded to 25% dextrose alone so the causeof hypoglycemia in this study was due to the consequence ofprolonged SE. Low HCO3 was seen in 19 cases and all were foundto have metabolic acidosis by ABG. 3 hypo natremias, 14 cases ofhypokalemias, 1 case of hyper kalemia, 11 cases of hypocalcemiaNo case of hyper calcemia or hyper natremia was seen..2. LP and CSF analysis was done in 70 cases either antimortum or postmortum in case of death. Out of them, 54 children had normal CSF,16 cases had abnormal CSF (elevated protein, decreased sugar,pleocytosis). 2 children had organisms in CSF.3. CT brain was done for 56 cases and found to be normal in 35 casesand abnormal in 21 cases. USG cranium was done in 39 cases andfound to be normal in 31 cases. MRI was done in 4 cases to confirmthe CT findings. CT brain was usually done in all cases of SE withfocal onset of seizures (28 cases) and it was abnormal in 25 cases(89.2%)4. We were not able to do bedside EEG or EEG during seizures. Interictal EEG was done for 54 children. All cases of febrile SE wereundergone for EEG (19 cases) and found to have normal EEG. 40cases had normal EEG and 14 had abnormal EEG.5. FINAL DIAGNOSIS: Most common causes of SE were remotesymptomatic ( structural lesions) – 34%, idiopathic epilepsy- 17%,Acute CNS infections- 15%, Febrile SE-15%, septic shock-7%.Others were toxin, drug over dose, acute encephalopathy. SUMMARY: In our study also duration > 1 hour, increasing distance from the place ofseizure onset, acute CNS infection, need for IPPV were significant independentrisk factors that predict poor out come.Commonest seizure type is GTCS and NCSE accounts for 20 % of SE.In our study also commonest seizure type is GTCS and NCSE account for 26%of SE. This may be because prolonged CSE in many cases (13.3%) resulted inNCSE due to neuro electro mechanical dissociation.Proper pre hospital therapy is associated with good out come observedin this study. No or improper pre hospital therapy is a significant risk factor forpoor outcome in univariate analysis. Kwong et al 83 concluded that Pre hospitalRx with BZD reduces adverse outcome. Allredge BK et al 92 also concludedthat, Pre hospital therapy was associated with shorter duration of SE (P=0.007),reduced likelihood of recurrent seizures in ER (P=0.045), no significantdifference between PR and IV and simplify the subsequent management ofthese patients.In this study, 57 cases (44.9%) presented as SE in heir first episode offits which is comparable with other literatures 2 and out of them, H/o poor drugcompliance was present in 14 cases and that could be the cause of SE in themwhere as 59.4% of the individuals had pervious epilepsy while 40.6% had notin Garzon et al 84 study and 43% has no prior SE in Mah JK et al 90 study,28/60(46.6%) were no h/o prior fits in Dunn DW et al 91 study, 16 patients(53.3%) had SE I episode with out prior H/o fits in Kalra veena et al 97 study. CONCLUSION: 1. Mortality in SE in this study is 15.7% . Higher mortality in this studyis mainly due to the underlying cause than SE itself. Most of thecases of SE were young children of <6 years of age and mortality isalso high in young children of <3 years who had 85% mortality. Butthere is no clear cut definition of SE is formulated in this age grouptill now.2. There is no significant sex difference.3. Commonest seizure type is GTCS. But NCSE also accounts for 26%of the cases.4. All were required supplementary oxygen at arrival and most of themwere apneic, hypoxic and shocky." @default.
• W2894327984 created "2018-10-05" @default.
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• W2894327984 date "2006-09-01" @default.
• W2894327984 modified "2023-09-27" @default.
• W2894327984 title "Clinical Profile, Immediate Outcome and Risk Factors Determining Adverse Outcome Of Status Epilepticus in Children: Managed in an Urban Tertiary Level Referral Centre" @default.
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