Clinical profile and outcome of refractory convulsive status epilepticus in older children from a developing country

• Most common etiology for CSE in children was acute symptomatic.
• Acute symptomatic etiology increased the odds of progression to RSE.
• 13.7% children died.
• RSE was significantly associated with disability at 6 months from discharge.

PurposeThe current study evaluates the etiology, clinical course and outcome of refractory convulsive status epilepticus (CSE) in older children.MethodsRetrospective analysis of data of 73 children with CSE, aged ≥2 and ≤12 years was performed. Odds ratios were calculated between variables for clinical course and outcome. Mortality of the group was analyzed using survival analysis.ResultsThirty three (45.2%) children progressed to refractory status epilepticus (RSE). The most common etiology for CSE was acute symptomatic in 44 (60.3%) of which 37 had presumed CNS infections. The odds of progressing to RSE were higher in children with acute symptomatic etiology (OR 2.62; CI – 95%; 0.99–7.14; p = 0.041). Progression to RSE increased the chances of severe sepsis by six times (OR 6.08; CI – 95%; 1.19–31.02; p = 0.036) and acidosis by nearly 15 times (OR 14.77; CI – 95%; 1.19–31.02; p = 0.020). Overall mortality was 13.7%, higher in RSE (21.2% vs.7.5%). Amongst the 63 surviving children followed for 1 year from discharge, progression to RSE increased the odds of disability by seven times (OR 7.08; CI 29.31; p = 0.004).ConclusionAcute symptomatic etiology was the commonest cause of CSE among older children from developing country and increased the odds of progressing to RSE. RSE was significantly associated with disability at 1 year from discharge.