ETIOLOGICAL CLASSIFICATION OF CONVULSIVE STATUS EPILEPTICUS IN CHILDREN ADMITTED IN A PEDIATRIC INTENSIVE CARE UNIT, OVER A PERIOD OF 10 YEARS

Objectives: To evaluate the etiology of convulsive status epilepticus (CSE), severe enough to require admission in a pediatric intensive care unit (ICU).

Methods: Seventy-three children (6.3+ 4.5 years) were admitted to our pediatric ICU with tonic clonic seizures, lasting more than 20 minutes, over the period 1991–2001. The Pediatric ICU of our Hospital covers every other day the total population of Athens (approximately 4 billions). Seizure etiology was classified in 1. Remote symptomatic CSE: occurring in a patient with a prior history of CNS defect 2. Febrile CSE: provoked evidently by fever 3. Acute symptomatic CSE: seizure occurring during acute CNS dysfunction of known (eg CNS infection, trauma) or undetermined cause in a patient without a prior CNS defect 4. Idiopathic: seizures with no acute CNS or metabolic dysfunction. Each patient was classified on the basis of clinical data such as demographic, duration and type of seizures, prior medical history, precipitating factors, brain imaging, biochemical and CSF findings, duration of ICU admission, clinical course, treatment, resistance to antiepileptics and short term outcome.

Results: Static or progressive encephalopathy had been diagnosed before the occurence of CSE in 39.7% (n=29). In 19 of these 29 cases seizures occurred during febrile illnesses. These patients were all classified in the remote symptomatic CSE group. Idiopathic CSE was found in 15.1% (n=11). Febrile CSE was found in 24.7% (n=18). Acute symptomatic CSE accounted for the rest 20.5% (n=15 cases, 11/15 cases due to CNS infection).

Conclusion: In practical management the first priority is to stop seizure as soon as possible but during this process many theoretical issues arise. Fever seems to be the most important clinical parameter in pediatric CSE. In a representative pediatric population the number of patients with CSE caused by either idiopathic epilepsy or CNS infection was almost the same. Better delineation of etiology and clinical characteristics of pediatric CSE should be useful for better management and a reasonably predictable outcome.