The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study

Objective: 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. Method: Demographic features, underlying etiologies, treatment modalities, electroencephalographic and neuroimaging outcomes of intensive care unit admissions between 2015 and 2019 were analyzed. Results: 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 newonset 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. Conclusion: PRISM-3 score is the independent risk factor of SRSE. Electrolyte abnormalities (hyponatremia and hypocalcemia) are associated with developing SRSE.