Early Clinical Variables Associated With Refractory Convulsive Status Epilepticus in Children.
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Peariso Katrina, Arya Ravindra, Glauser Tracy, Abend Nicholas S, Barcia Aguilar Cristina, Amengual-Gual Marta, Anderson Anne, Appavu Brian L, Brenton J Nicholas, Carpenter Jessica, Chapman Kevin E, Clark Justice, Gaillard William D, Gaínza-Lein Marina, Goldstein Joshua, Goodkin Howard, Grinspan Zachary, Guerriero Rejean M, Horn Paul S, Huh Linda, Kahoud Robert, Kelley Sarah A, Kossoff Eric H, Kapur Kush, Lai Yi-Chen, Marquis B Oyinkan, McDonough Tiffani, Mikati Mohamad A, Morgan Lindsey, Novotny Edward, Ostendorf Adam P, Payne Eric T, Piantino Juan, Riviello James, Sands Tristan, Stafstrom Carl E, Tasker Robert C, Tchapyjnikov Dmitry, Vasquez Alejandra, Wainwright Mark S, Wilfong Angus, Williams Korwyn, Loddenkemper Tobias, for Pediatric Status Epilepticus Research Group (pSERG)
Аннотация
METHODS: An observational case-control study was conducted comparing pediatric patients (1 month-21 years) with convulsive SE whose seizures stopped after benzodiazepine (BZD) and a single second-line antiseizure medication (ASM) (responsive established status epilepticus [rESE]) with patients requiring more than a BZD and a single second-line ASM to stop their seizures (RSE). These subpopulations were obtained from the pediatric Status Epilepticus Research Group study cohort. We explored clinical variables that could be acquired early after presentation to emergency medical services with univariate analysis of the raw data. Variables with p < 0.1 were retained for univariable and multivariable regression analyses. Multivariable logistic regression models were fit to age-matched and sex-matched data to obtain variables associated with RSE.
RESULTS: We compared data from a total of 595 episodes of pediatric SE. Univariate analysis demonstrated no differences in time to the first BZD (RSE 16 minutes [IQR 5-45]; rESE 18 minutes [IQR 6-44], p = 0.068). Time to second-line ASM was shorter in patients with RSE (RSE 65 minutes; rESE 70 minutes; p = 0.021). Both univariable and multivariable regression analyses revealed a family history of seizures (OR 0.37; 95% CI 0.20-0.70, p = 0.0022) or a prescription for rectal diazepam (OR 0.21; 95% CI 0.078-0.53, p = 0.0012) was associated with decreased odds of RSE.
DISCUSSION: Time to initial BZD or second-line ASM was not associated with progression to RSE in our cohort of patients with rESE. A family history of seizures and a prescription for rectal diazepam were associated with a decreased likelihood of progression to RSE. Early attainment of these variables may help care for pediatric rESE in a more patient-tailored manner.
CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that patient and clinical factors may predict RSE in children with convulsive seizures.