PEDIATRIC STATUS EPILEPTICUS IN HONDURAS, CENTRAL AMERICA

Objectives: To assess the incidence, etiology, treatment, and outcome of status epilepticus (SE) in Honduran children.

Methods: Patients consisted of all cases of SE (seizure >30min or series of seizures >30min with no recovery in between) in children from one month to 16 years of age who presented to Hospital Escuela Materno-Infantil Emergency Department in Tegucigalpa, Honduras over 13 weeks. A surveillance study was performed with enrollment of consecutive cases and then records were reviewed to determine subsequent treatment and outcome. All cases with seizure duration >10min were screened to ensure capturing SE cases. Etiologies were classified according to the guidelines for epidemiologic research of the International League Against Epilepsy.

Results: There were 59 children screened of whom 47 met the criteria for SE. The mean age was 4.5 years with 51% boys and 62% from rural areas. Nineteen (40%) had a history of prior unprovoked seizures and 13 (28%) had a history of prior provoked seizures. Nineteen (40%) were on anti-epileptic drug therapy. The mean duration of SE was 541min (median 95min, range 30–12960min). Etiologies included 6 (13%) cryptogenic, 4 (9%) remote symptomatic, 9 (19%) febrile, and 28 (60%) acute symptomatic. There were 6 (13%) deaths. At follow-up, new neurological deficits were present in 4 (9%). Outcome was primarily a function of etiology. Conclusion: SE is common in the developing country of Honduras. Due to the distances involved, there are long delays before effective medical therapy can be given in pediatric hospital emergency rooms. This leads to a very long duration of SE and a likely skew towards the more difficult cases reaching the hospital. Approaches focusing on pre-hospital treatment in the child's home community may be of particular importance in this setting.