dalila boumendil

ABSTRACT:

Introduction: Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are serious and frequent neurological emergencies in children associated with high morbidity and mortality. Despite this, we note the absence of published Algerian data. The aim of this work is to determine the demographic data, the etiologies, and the factors of progression in RCSE and SuperRCSE as well as the short-term prognosis.

Design: Prospective observational study with retrospective analysis of all the episodes of RCSE and Super-RCSE treated between January 1, 2008, and April 30, 2016. Setting: Pediatric Intensive Care Unit, University Hospital of Oran, Algeria. Patients: RCSE is defined as seizure activity that persists after administration of a first-line benzodiazepine (BZD) and a second-line antiepileptic drug (AED). Super-RCSE is defined as «SE that has continued or recurred despite 24 hours of general anesthesia. » Factors independently associated with Refractory and Super-RCSE were established through univariate and multivariable analyses. The outcome was evaluated using the Glasgow Outcome Score.

 Results: Among 443 patients with status epilepticus, 140 patients (31.6%) were afflicted with refractory status epilepticus and 25 (5.6%) with SRSE. The mean age of the entire cohort was 40.65 ± 2.16 months [1 – 180 months].135 patients (33.8%) had suffered previous seizures; RCSE was related to younger age (< 3 years) (OR 1.76; 95% CI 1,018 – 3,058) p=0.043, duration of status epilepticus >2 h (OR 3.096; 95% CI 1, 77 – 5, 39) p= 10⎺⁴, acute symptomatic etiologies (OR 3.609; 95% CI 2,112 – 6.166), Severe consciousness impairment (GCS < 13/15) before treatment (OR 18.55; 95% CI 8,202 – 41.972) p= 10⎺⁴ and Non respect of the therapeutic protocol upstream of PICU (OR 3.659; 95% CI 1,926 – 6.949) p= 10⎺⁴. Super-RCSE was independently associated with age greater than 3 years (OR 3.28; p=0.018), indeterminate etiology (OR 6.628; p=0.009), encephalitis (OR 4. 782; p=0.003) and use of Vasopressor medications (OR 4.239; p=0.007). Overall mortality was 83 (20.75%).

Conclusion The etiologies of CSE are heterogeneous, with a significant incidence of RCSE in the acute symptomatic group. Encephalitis was the determinant of the progression of CSE to Super-RCSE. The therapeutic success of which depends on whether or not the cause of CSE can be treated.

Keywords: Refractory status epilepticus; Super-Refractory status epilepticus; Etiology; PICU; Outcome; Children. Abbreviations: SE: Status Epilepticus, RCSE: Refractory Convulsive Status Epilepticus, NRCSE: Non-Refractory Convulsive Status Epilepticus, Super-RCSE: Super-Refractory Convulsive Status Epilepticus, BZD: Benzodiazepine, AED: Antiepileptic Drogue, CNS: Central Nervous System