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OUTCOME OF REFRACTORY STATUS EPILEPTICUS IN CHILDREN

Objective: To determine the outcome of refractory status epilepticus in children and factors affecting the outcome. Study Design: Descriptive cross sectional study Place and Duration of Study: Children’s Hospital & Institute of Child Health, Lahore, Pakistan from August 2019 to March 2020. Methodology: The study was conducted on children presenting with refractory status epilepticus. A proforma was used for recording predictive factors. Modified Rankin Scale prior to presentation and Glasgow Coma Scale at presentation were documented and compared with discharge scores. Results: Out of 75 children, 46 were males with mean age of patients was 4.43 ± 3.47 years. Common etiologies were acute symptomatic in 37 (49.3%), progressive encephalopathy in 19 (25.3%), static encephalopathy in 9 (11.9%), remote symptomatic in 4 (5.3%), acute on remote symptomatic in 3 (4%), idiopathic and unclassified in remaining patients. Mean time between seizures onset and first benzodiazepine injection was 44 ± 36 minutes. Duration of RSE was <24 hours in 17 (22.7%), 24-48 hours in 15 (20%), 48-72 hours in 14 (18.6%), 72-96 hours in 12 (16%) and >96 hours in 17 (22.7%). At discharge 33 (44%) returned to baseline, 31 (41%) developed neurological disability while 11(15%) expired during the stay. Etiology and duration of status epilepticus had significant impact on outcome with p-value of 0.021 and 0.041, respectively. Conclusion: Acute etiology was associated with higher mortality whereas return to baseline was also fair among survivors. This poses implications for emergency management to significantly improve the treatment outcomes.