ABSTRACT

To analyze the clinical features of prolonged seizures and status epilepticus and perform risk analysis on super refractory status epilepticus (SRSE) in pediatric intensive care unit (PICU) admissions.

Demographic features, underlying etiologies, treatment modalities, electroencephalographic and neuroimaging outcomes of intensive care unit admissions between 2015 and 2019 were analyzed.

Seventy-one children were enrolled. The most common etiologic factors for prolonged seizure were fever in 45.1%, (central nervous system infection: 16.9%, infection other than central nervous system: 28.2%), withdrawal of the antiepileptic medication in 40.9%, intoxications in 12.7% of the children and intracranial hemorrhage due to arteriovenous malformation in one (1.4%) patient. At admission hypoglycemia was detected in 23.9%, hypocalcemia in 18.3%, hyponatremia in 15.5%, acidosis in 35.2%, and increased lactate levels in 25.4% of the patients. The patients were grouped based on fever at admission and new- onset seizure. Approximately 45.1% of the population had fever at admission and consisted of younger children compared to their counterparts (p=0.023). Children with pre-existing epilepsy had frequent history of sibling death, while patients presented with new-onset seizure had more often significant lactate elevations, acidosis, and required mechanical ventilation at admission (p=0.002, p=0.008, p=0.017). Twelve (16.9%) patients developed SRSE. Low serum sodium and calcium levels increased the risk of developing SRSE (OR: 10.800, 95%CI: 2.518-46.318; OR: 4.554, 95%CI: 1.159-17.892). However PRISM-3 score has been identified as the single independent risk factor for SRSE (OR: 1.174, 95% CI: 1.039-1.327). Three (4.2%) children died of secondary complications during their stay in intensive care unit . Tracheostomy cannulation was performed in two (16.7%) SRSE patients due to neurological incapability to maintain a patent airway.

PRISM-3 score is the independent risk factor of SRSE. Electrolyte abnormalities (hyponatremia and hypocalcemia) are associated with developing SRSE.

Keywords: Seizure, Status epilepticus, Super refractory status epilepticus, Hyponatremia