The predictive factors for prolonged seizures and status epilepticus: a single center study

Objectives: 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 outcome of intensive care unit admissions between 2015 and 2019 were analyzed. Results: Seventy-one children were enrolled. The common etiology for prolonged seizure was fever in 45.1% of the children (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. Initial diagnostics exhibited 23.9% of hypoglycemia, 18.3% of hypocalcemia, 15.5% of hyponatremia, 35.2% of acidosis, and 25.4% of elevated lactate. Group categorizations were based on fever and new onset of seizure. Approximately 45.1% of the population acquired fever at the onset 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 with new-onset of seizure possessed significant lactate elevations, acidosis, and required mechanical ventilation more often (p=0.002, p=0.008, p=0.017). Twelve (16.9%) patients developed SRSE. Low serum sodium and calcium levels were associated with 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 the single independent risk factor in children proceeding to SRSE (OR: 1.174, 95% CI: 1.039-1.327). Three (4.2%) children died of secondary complications. 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.