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

Müge AYANOĞLU, (Sivas Numune Devlet Hastanesi, Çocuk Nöroloji Kliniği, Sivas, Türkiye)
Ebru Atike ONGUN (Cumhuriyet Üniversitesi, Çocuk Yoğun Bakım Ünitesi, Sivas, Türkiye)
Bakırköy Tıp Dergisi
10 0
Yıl: 2021 Cilt: 17 Sayı: 1 Sayfa Aralığı: 53 - 63 Metin Dili: İngilizce DOI: 10.5222/BMJ.2021.16362 İndeks Tarihi: 20-05-2021

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

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

Uzamış Nöbet ve Status Epileptikus için Risk Faktörleri: Tek Merkez Deneyimi

Öz:
Amaç: Çocuk yoğun bakım ünitelerindeki uzamış nöbet ve status epileptikusun klinik özelliklerinin analiz edilmesi ve süper direçli status epileptikusun (SRSE) risk analizinin yapılmasıGereç-Yöntem: 2015-2019 yılları arasında çocuk yoğun bakım ünitesine başvuran uzamış nöbet ve status epileptikus olgularının demografik özellikleri, altta yatan etiyolojileri, tedavi modaliteleri, elektroensefalografik ve nörogörüntüleme sonuçları incelendi.Bulgular: Yetmiş bir olgu çalışmaya dahil edildi. En sık etyolojik nedenlerin %45.1 olguda ateş (santral sinir sistemi enfeksiyonları: %16.9, santral sinir sistemi dışında enfeksiyonlar: %28.2), %40.9 olguda antiepileptik tedavinin kesilmesi, %12.7 olguda intoksikasyonlar ve bir olguda (%1.4) arteriovenöz malformasyona bağlı intrakraniyal kanama olduğu gözlendi. Başvuru anında %23.9 olguda hipoglisemi, %18.3 olguda hipokalsemi, %15.5 olguda hiponatremi, %35.2 olguda asidozis ve %25.4 olguda artmış laktat seviyeleri saptandı. Olgular, nöbet esnasında ateş varlığı ile önceden geçirilmiş nöbet öyküsü olup olmamasına göre gruplara ayrıldı. Başvuru anında ateş, % 45.1 olguda mevcut iken, bu olguların afebril nöbet geçirenlere göre daha küçük yaşta hastalardan oluştuğu görüldü (p=0.023). Önceden geçirilmiş nöbet öyküsüne sahip olgularda sık kardeş ölüm öyküsünün olduğu, ilk kez nöbet ile başvuran olgularda ise yatış anında laktat yüksekliği ve asidozun belirgin, mekanik ventilasyon gereksinimin ise sık olduğu gözlendi (p=0.002, p=0.008, p=0.017). Oniki (%16.9) hastada SRSE gelişti. Bu olgularda düşük serum sodyum ve kalsiyum seviyelerinin SRSE gelişim riskini artırdığı anlaşıldı (OR: 10.800, 95% CI: 2.518-46.318; OR: 4.554, 95% CI: 1.159-17.892). Çoklu regresyon analizinde, PRISM-3 skorunun SRSE için tek bağımsız risk faktörü olduğu saptandı (OR: 1.174, 95% CI: 1.039-1.327). Üç (%4.2) olgu, çocuk yoğun bakım yatışı esnasında ikincil komplikasyonlar sonucu kaybedildi. SRSE gelişen iki olguda (%16.7) nörolojik olarak hava yolu açıklığını koruyamama nedeniyle trakeostomi kanülizasyonu uygulandı.Sonuç: PRISM-3 skoru SRSE için bağımsız risk faktörüdür. Elektrolit dengesizliği (hiponatremi, hipokalsemi) SRSE gelişimiyle ilişkilidir.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1.Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus - Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-23. doi: 10.1111/epi.13121.
  • 2.Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol. 2015;14:615-24. doi: 10.1016/S1474-4422(15)00042-3.
  • 3.Devinsky O, Vezzani A, Najjar S, DeLanerolle NC, Rogawski MA. Glia and epilepsy: excitability and inflammation. Trends Neurosci. 2013;36:174-84. doi: 10.1016/j.tins.2012.11.008.
  • 4.Sutter R, Dittrich T, Semmlack S, Rüegg S, Marsch S, Kaplan PW. Acute systemic complications of convulsive status epilepticus - a systematic review. Crit Care Med. 2018;46:138-45. doi: 10.1097/CCM.0000000000002843.
  • 5.Tiamkao S, Pranbul S, Sawanyawisuth K, Thepsuthammarat K, Integrated Epilepsy Research Group. A national database of incidence and treatment outcomes of status epilepticus in Thailand. Int J Neurosci. 2014;124:416-20. doi: 10.3109/00207454.2013.850084.
  • 6.Lv Rj, Wang Q, Cui T, Zhu F, Shao XQ. Status epilepticus-related etiology, incidence and mortality: A meta-analysis. Epilepsy Res. 2017;136:12-7. doi: 10.1016/j.eplepsyres.2017.07.006.
  • 7.Dham BS, Hunter K, Rincon F. The epidemiology of status epilepticus in the United States. Neurocrit Care. 2014;20:476-83. doi: 10.1007/s12028-013-9935-x.
  • 8.Berg AT, Shinnar S, Testa FM, et al. Status epilepticus after the initial diagnosis of epilepsy in children. Neurology. 2004;63:1027-34. doi: 10.1212/01.WNL.0000138425.54223.DC.
  • 9.Riviello JJ, Ashwal S, Hirtz D, et al. Practice parameter: Diagnostic assessment of the child with status epilepticus (an evidence-based review). Neurology. 2006;67:1542-50. doi: 10.1212/01.wnl.0000243197.05519.3d.
  • 10.Marik PE, Varon J. The management of status epilepticus. Chest. 2004;126:582-91. doi: 10.1378/chest.126.2.582.
  • 11.Abou Khaled KJ, Hirsch LJ. Updates in the management of seizures and status epilepticus in critically ill patients. Neurol Clin. 2008;26(2):385-408. doi: 10.1016/j.ncl.2008.03.017.
  • 12.Kantanen A, Sairanen J, Kälviäinen R. Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study. Epilepsy Behav. 2019; 101(Pt B):106413. doi: 10.1016/j.yebeh.2019.07.014.
  • 13.Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain. 2012;135:2314-28. doi: 10.1093/brain/aws091.
  • 14.Lewena S, Young S. When benzodiazepines fail: how effective is second line therapy for status epilepticus in children. Emerg Med Australas. 2006;18:45-50. doi: 10.1111/j.1742-6723.2006.00807.x.
  • 15.Barzegar M, Mahdavi M, Galegolab Behbehani A, Tabrizi A. Refractory convulsive status epilepticus in children: etiology, associated risk factors and outcome. Iran J Child Neurol. 2015;9(4):24-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670974/
  • 16.Kravljanac R, Djuric M, Jankovic B, Pekmezovic T. Etiology, clinical course and response to the treatment of status epilepticus in children: a 16-year single-center experience based on 602 episodes of status epilepticus. Eur J Paediatr Neurol. 2015;19:584-90. doi: 10.1016/j.ejpn.2015.05.007.
  • 17.Rai S, Drislanane F. Treatment of refractory and super-refractory status epilepticus. Neurotherapeutics. 2018;15(3):697-712. doi: 10.1007/s13311-018-0640-5.
  • 18.Nardone R, Brigo F, Trinka E. Acute symptomatic seizures caused by electrolyte disturbances. J Clin Neurol. 2016;12(1):21-33. doi: 10.3988/jcn.2016.12.1.21.
  • 19.Arayakarnkul P, Chomtho K. Treatment options in pediatric super-refractory status epilepticus. Brain Dev. 2018;41(4):359-66. doi: 10.1016/j.braindev.2018.11.011.
  • 20.Maytal J, Shinnar S, Moshe SL, Alvarez LA. Low morbidity and mortality of status epilepticus in children. Pediatrics. 1989;83(3):323-31. PMID: 2919138.
  • 21.Trinka E, Hofler J, Leitinger M, Brigo F. Pharmacotherapy for status epilepticus. Drugs. 2015;75:1499-521. doi: 10.1007/s40265-015-0454-2.
  • 22.Pujar SS, Martinos MM, Cortina‐Borja M, et al. Long‐term prognosis after childhood convulsive status epilepticus: a prospective cohort study. Lancet Child Adolesc Heal. 2018;2(2):103-11. doi: 10.1016/S2352-4642(17)30174-8.
  • 23.Nelson‐Chaure M, Chin RF, Neville BG, Scott RC. Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol. 2006;5(9): 769-79. doi: 10.1016/S1474-4422(06)70546-4.
  • 24.Glauser T, Shinnar S, Gloss D, et al. Evidence based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the american epilepsy society. Epilepsy Curr. 2016;16:48-61. doi: 10.5698/1535-7597-16.1.48.
  • 25.Lacroix J, Deal C, Gauthier M, Rousseau E, Farrell CA. Admissions to a pediatric intensive care unit for status epilepticus: a 10-year experience. Crit Care Med. 1994;22:827-32. doi: 10.1097/00003246-199405000-00019.
  • 26.Chin RF, Neville BG, Peckham C, et al. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2016;368(9531):222-29. doi: 10.1016/S0140-6736(06)69043-0.
  • 27.Fountain NB. Status epilepticus: risk factors and complications. Epilepsia. 2000;41:23-30. doi: 10.1111/j.1528-1157.2000.tb01521.x.
  • 28.Dragoumi P, Tzetzi O, Vargiami E, et al. Clinical course and seizure outcome of idiopathic childhood epilepsy: determinants of early and longterm prognosis. BMC Neurol. 2013;13:206. doi: 10.1186/1471-2377-13-206.
  • 29.Chegondi M, Garland MM, Sendi P, Jayakar AR, Totapally B. Course and outcome of children with convulsive status epilepticus admitted to a pediatric intensive care unit. Cureus. 2019;11(4):e4471. doi: 10.7759/cureus.4471.
  • 30.Berg AT, Shinnar S. Complex febrile seizures. Epilepsia. 1996;37:126-33. doi: 10.1111/j.1528-1157.1996.tb00003.x.
  • 31.Berg AT, Shinnar S, Hauser WA, et al. A prospective study of recurrent febrile seizures. N Engl J Med. 1992;327:1122-7. doi: 10.1056/NEJM199210153271603.
  • 32.Maytal J, Shinnar S. Febrile status epilepticus. Pediatrics. 1990;86:611-6.
  • 33.Nelson KB, Ellenberg JH. Prognosis in children with febrile seizures. Pediatrics. 1978;61(5):720-7. PMID: 662510.
  • 34.Shinnar S, Hesdorffer DC, Nordli DR, et al. Phenomenology of prolonged febrile seizures: Results of the FEBSTAT study. Neurology. 2008;71(3):170-6. doi: 10.1212/01.wnl.0000310774.01185.97.
  • 35.Shinnar S, Pellock JM, Berg AT, et al. Short-term outcomes of children with febrile status epilepticus. Epilepsia. 2001;42:47-53. doi: 10.1046/j.1528-1157.2001.10000.x.
  • 36.Sofijanov N, Emoto S, Kuturec M, et al. Febrile seizures: Clinical characteristics and initial EEG. Epilepsia. 1992;33:52-7. doi: 10.1111/j.1528-1157.1992.tb02282.x.
  • 37.OECD. Enrolment in childcare and pre-school. OECD Family Database; 2019. p. 1-8. Available from: http://www.oecd.org/els/soc/PF3_2_Enrolment_childcare_preschool.pdf
  • 38.Matz O, Zdeblik C, Zechbauer S, Bündgens L, Litmathe J, Willmes K. Lactate as a diagnostic marker in transient loss of consciousness. seizure. 2016;40:71-5. doi: 10.1016/j.seizure.2016.06.014.
  • 39.Fullor BM, Dellinger RP. Lactate as a hemodynamic marker in the critically ill. Curr Opin Crit Care. 2012;18(3):267-72. doi: 10.1097/MCC.0b013e3283532b8a.
  • 40.Shuai J, Bikson M, Hahn PJ, Lian J, Durand DM. Ionic mechanisms underlying spontaneous CA1 neuronal firing in Ca2+-free solution. Biophys J. 2003;84(3):2099-111. doi: 10.1016/S0006-3495(03)75017-6.
  • 41.Yue WD, Zhang YH, Gu F, Wang J, Zhang JY, Gu R. Mechanisms underlying low [Ca2+]-induced increased excitability of hippocampal neurons. Neurosci Bull. 2008;24(6):367-73. doi: 10.1007/s12264-008-0429-3.
  • 42.Farrar HC, Chande VT, Fitzpatrick DF, et al. Hyponatremia as the cause of seizures in infants: a retrospective analysis of incidence, severity, and clinical predictors. Ann Emerg Med. 1995;26:42-8. doi: 10.1016/S0196-0644(95)70236-9.
  • 43.Sterns RH, Thomas DJ, Herndon RM. Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int. 1989;35:69-75. doi: 10.1038/ki.1989.9.
  • 44.Barolomei F, Gastaut JL. Complex partial status epilepticus provoked by hyponatremia. Eur Neurol. 1998;40(1):53-4. PMID: 9729113.
  • 45.Hirtz D, Ashwal S, Berg A, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology. 2000;55:616-23. doi: 10.1212/WNL.55.5.616.
  • 46.Castilla-Guerra L, del Carmen Fernández-Moreno M, Lopez-Chozas JM, Fernández-Bolaños R. Electrolytes disturbances and seizures. Epilepsia. 2006;47(12):1990-8. doi: 10.1111/j.1528-1167.2006.00861.x.
  • 47. Zifman E, Alehan F, Menascu S, et al. Clinical characterization of gastroenteritis-related seizures in children: impact of fever and serum sodium levels. J Child Neurol. 2011;26:1397-400. doi: 10.1177/0883073811409222.
  • 48. Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005;75:534-9. doi: 10.1136/jnnp.2004.041947.
  • 49. Bellante F, Legros B, Depont C, Creteur J, Taccone FS, Gaspard N. Midazolam and thiopental for the treatment of refractory status epilepticus: a retrospective comparison of efficacy and safety. J Neurol. 2016;263:799-806. doi: 10.1007/s00415-016-8074-7.
  • 50.Topjian AA, Gutierrez-Colina AM, Sanchez SM, et al. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med. 2013;41(1):215-23. doi: 10.1097/CCM.0b013e3182668035.
  • 51.Payne ET, Zhao XY, Frndova H, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014;137:1429-38. doi: 10.1093/brain/awu042.
  • 52. Gulla KM, Sachdev A. Illness severity and organ dysfunction scoring in pediatric intensive care unit. Indian J Crit Care Med. 2016;20:27-35. doi: 10.4103/0972-5229.173685.
  • 53. Shorvon S. Super-refractory status epilepticus: An approach to therapy in this difficult clinical situation. Epilepsia. 2011;52:53-6. doi: 10.1111/j.1528-1167.2011.03238.x.
  • 54. Sadik KC, Mishra D, Jureya M, Jhamb U. Clinico-etiological profile of pediatric refractory status epilepticus at a public hospital in India. J Epilepsy Res. 2019;9:36-41. doi: 10.14581/jer.19004.
  • 55. Sahin S, Yazici MU, Ayar G, Karalok ZS, Arhan EP. Seizures in a pediatric intensive care unit: a prospective study. J Trop Pediatr. 2016;62(2):94-100. doi: 10.1093/tropej/fmv076.
  • 56. Komur M, Arslankoylu AE, Okuyaz Ç, Keçeli M, Derici D. Management of patients with status epilepticus treated at a pediatric intensive care unit in Turkey. Pediatr Neurol. 2012;46:382-6. doi: 10.1016/j.pediatrneurol.2012.03.013.
  • 57. Specchio N, Pietrafusa N, Bellusci M, et al. Pediatric status epilepticus: Identification of prognostic factors using the new ILAE classification after 5 years of follow‐up. Epilepsia. 2019;60(12):2486-98. doi: 10.1111/epi.16385.
APA ayanoglu m, Ongun E (2021). The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. , 53 - 63. 10.5222/BMJ.2021.16362
Chicago ayanoglu muge,Ongun Ebru Atike The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. (2021): 53 - 63. 10.5222/BMJ.2021.16362
MLA ayanoglu muge,Ongun Ebru Atike The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. , 2021, ss.53 - 63. 10.5222/BMJ.2021.16362
AMA ayanoglu m,Ongun E The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. . 2021; 53 - 63. 10.5222/BMJ.2021.16362
Vancouver ayanoglu m,Ongun E The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. . 2021; 53 - 63. 10.5222/BMJ.2021.16362
IEEE ayanoglu m,Ongun E "The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study." , ss.53 - 63, 2021. 10.5222/BMJ.2021.16362
ISNAD ayanoglu, muge - Ongun, Ebru Atike. "The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study". (2021), 53-63. https://doi.org/10.5222/BMJ.2021.16362
APA ayanoglu m, Ongun E (2021). The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. Bakırköy Tıp Dergisi, 17(1), 53 - 63. 10.5222/BMJ.2021.16362
Chicago ayanoglu muge,Ongun Ebru Atike The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. Bakırköy Tıp Dergisi 17, no.1 (2021): 53 - 63. 10.5222/BMJ.2021.16362
MLA ayanoglu muge,Ongun Ebru Atike The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. Bakırköy Tıp Dergisi, vol.17, no.1, 2021, ss.53 - 63. 10.5222/BMJ.2021.16362
AMA ayanoglu m,Ongun E The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. Bakırköy Tıp Dergisi. 2021; 17(1): 53 - 63. 10.5222/BMJ.2021.16362
Vancouver ayanoglu m,Ongun E The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study. Bakırköy Tıp Dergisi. 2021; 17(1): 53 - 63. 10.5222/BMJ.2021.16362
IEEE ayanoglu m,Ongun E "The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study." Bakırköy Tıp Dergisi, 17, ss.53 - 63, 2021. 10.5222/BMJ.2021.16362
ISNAD ayanoglu, muge - Ongun, Ebru Atike. "The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study". Bakırköy Tıp Dergisi 17/1 (2021), 53-63. https://doi.org/10.5222/BMJ.2021.16362
Sayfa Oluşturulma Tarihi
17-04-2024 19:34

İLETİŞİM

TÜBİTAK ULAKBİM TR Dizin

Yüzüncüyıl, İşçi Blokları Mahallesi

Muhsin Yazıcıoğlu Caddesi No:51/C

06530 Çankaya / ANKARA +90 (312) 298 92 00

trdizin@tubitak.gov.tr

TÜBİTAK ULAKBİM Ulusal Akademik Ağ ve Bilgi Merkezi Cahit Arf Bilgi Merkezi © Tüm Hakları Saklıdır. Gizlilik Politikası Kullanım Şartları