Refractory and super-refractory status epilepticus in children and adolescents: A population-based study

• Published in: Seizure (London, England) England), 2024-08, Vol.120, p.116-123
• Main Authors: Hepsø, Seline W., Lee, Maya, Noszka, Kristoffer, Wollertsen, Yvonne Myrtvedt, Holmaas, Gunhild, Kristensen, Erle, Eichele, Tom, Bjork, Marte-Helene, Griffiths, Silja T., Hikmat, Omar
• Format: Article
• Language: English
• Subjects: Adolescent; Anticonvulsants - therapeutic use; Child; Child, Preschool; Drug Resistant Epilepsy - diagnosis; Drug Resistant Epilepsy - epidemiology; Drug Resistant Epilepsy - therapy; Female; Humans; Incidence; Infant; Male; Pediatric; Refractory; Retrospective Studies; Seizures; Status epilepticus; Status Epilepticus - diagnosis; Status Epilepticus - epidemiology; Status Epilepticus - therapy; Super-refractory
• ISSN: 1059-1311; 1532-2688; 1532-2688
• DOI: 10.1016/j.seizure.2024.06.023

•The incidence of RSE/SRSE in children/adolescents is 3/100,000.•Delays in initiating treatment occurred in various stages during RSE/SRSE.•Simple SE treatment protocols and regular training may overcome these delays.•The pre-hospital administration of second-line treatment should be considered. Refractory (RSE) and super-refractory status epilepticus (SRSE) are serious medical emergencies whose long-term outcomes depend on the timeliness of their management. Population-based clinical and epidemiological data on these conditions are sparse. We aimed to provide a detailed description of the epidemiology and clinical course of RSE and SRSE in children and adolescents and identify potential prognostic biomarkers. In this retrospective population-based study, patients aged one month to 18 years who fulfilled the RSE/SRSE diagnostic criteria and were admitted to the intensive care unit of Haukeland University Hospital from 2012 to 2021 were considered eligible. Detailed clinical and laboratory findings along with information on management and outcomes were systematically analyzed. Forty-three patients with 52 episodes of RSE/SRSE were identified. The incidence rate was 3.13 per 100,000 per year. The median time from SE onset to the administration of the first rescue drug was 13 min, and from the first rescue drug to second- and third-line treatments, 83 and 66 min, respectively. All patients were alive at discharge. Delays in treatment were observed in various stages of the clinical course of RSE/SRSE. Improvement measures targeting the prompt administration of recuse mediation and subsequent treatment escalation are needed. Graphical abstract [Display omitted]