A STUDY OF CLINICAL PROFILE & OUTCOME OF STATUS EPILEPTICUS IN A PEDIATRIC TERTIARY CARE HOSPITAL
Sachin Admuthe*, Nitin Tikare**, L.H. Bidari***, Vinayak Revankar ****
Dr. Bidari's Ashwini Institute of Child Health & Research Centre, Bijapur. *, Dr. Bidari's Ashwini Institute of Child Health & Research Centre, Bijapur. **, Dr. Bidari's Ashwini Institute of Child Health & Research Centre, Bijapur. ***, Dr. Bidari's Ashwini Institute of Child Health & Research Centre, Bijapur. ****
Introduction
Status Epilepticus is a major medical and neurological emergency. Despite advances in its treatment, it is still associated with significant mortality and morbidity.

Objective: To study the clinical profile of Status Epilepticus in children.

Design: Retrospective Study

Setting: Dr. Bidari's Ashwini Institute of Child Health & Research Centre, Bijapur.

Methodology:

Case records of patients admitted with Status Epilepticus in PICU in Dr. Bidari's Ashwini Children's Hospital between January 2004 to December 2004 were studied retrospectively. They were evaluated for their clinical presentation, laboratory parameters, treatment profile and immediate outcome.

Results:

There were 27 patients who presented with status epilepticus. Their age group ranged from 4 months to 13 years with a mean of 4.5-3.69 years. Boys and girls were almost in equal proportion (15:12). 10 patients (37.04%) with status epilepticus had previous history of seizure activity. The remaining 17 (62.96%) presented with status epilepticus as the first presentation without prior history of seizure activity. Of the seventeen, 6 were idiopathic, 2 had febrile status epilepticus and 9 had acute symptomatic (Viral encephalitis-4, pyogenic meningitis-2, Pertussis encephalopathy-2, head injury-1). Seizures were generalized in 24 (88.89%) and focal in 3 (11.12%) children. Duration of seizures prior to presentation was less than one hour in 20 (74.07%) and more than one hour in 7 (25.93%). Most common drugs for initial seizure control were a combination of Midazolam and Phenytoin in 19 patients. Three or more drugs were required in eight patients of which three required midazolam infusion and one pentobarbital infusion. Three patients required ventilatory support. CT Scan head was done in 17 children. Cerebral edema was the most common finding in 8 patients (47.06%) followed by Cerebral atrophy (29.41%). Overall immediate outcome revealed two deaths (7.4%), two left against medical advise (7.4%) and 23 children improved.

Conclusions:
  1. Status epilepticus, while a challenge to the pediatrician, can be treated with drugs that are commonly used.
  2. Generalized Status Epilepticus is the most common type.
  3. The majority of children presented with Status Epilepticus at the first presentation are without a prior history of seizure activity.
  4. Most children with Status Epilepticus respond to combination of Midazolam and Phenytoin.
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