Status epilepticus; etiology, clinical features and treatment protocols

Purpose: In this study; status epilepticus (SE) which is the most important neurological emergency in pediatric population was searched in the children and adolescents who were followed up in Cukurova University Medical Faculty of Pediatric Intensive Care Unit with the aim of enlightening diagnosis, etiological factors, clinical features, recurrence and treatment protocols of status epilepticus. Materials and Methods: We enrolled 128 convulsive SE cases of 86 patients who were followed up Cukurova University Medical Faculty of Pediatric Intensive Care Unit between January 2010-June 2015. The factors that are effective on demographical properties, seizure type, SE etiology, neuroradiological and electroencephalography (EEG) findings, recurrence, treatment protocols and also lenght of intensive care unit stay were reviewed retrospectively. Obtained results were compared statistically. Results: Mean age of cases was 5,1±5,0 years (between 1/12 - 18 years). Seizure etiologies comprised chronic symptomatic in 85 (%67), acute symptomatic in 21 (%16), febrile in17 (%13) and idiopathic in 5 (%3,9). Seizure duration was; < 30 minutes in 53 (%41,4) cases, 30-60 minutes in 29 (%22,7) cases and more than 60 minutes in 49 (%35,9) cases. History of seizure in newborn period and also prior epilepsy diagnosis were determined as risk factors for recurrence (p<0,05). In addition to, abnormalities at neurological examination, neuroradiology and EEG record were associated with increased risk of relapses (p<0,05). In acute symptomatic etiology risk of recurrence was more than chronic symptomatic etiology (p=0,028). Treatment before hospital admission was no effective on seizure duration, risk of recurrence and length of stay in intensive care unit. With the review of treatment protocols, the effectiveness of levetiracetam which is a new generation antiepileptic drug was shown in seizure control. It is also shown that levetiracetam reduced the need of midazolam infusion for controlling seizure. The mean length of stay in intensive care unit was 10,5±12,6 (ranging from 1 to 81) days. In acute symptomatic etiology, length of stay in intensive care unit was more than chronic symptomatic and febrile etiology (p<0,05). Conclusion: In this study; risk factors for recurrence were shown as history of seizure in newborn period, chronic symtomatic etiology and abnormalities in neurological examination, neuroradiology and EEG records. For the management of a single treatment protocol; further evidence-based, prospective, randomised and multicentre studies are required.