European Journal of Cardiovascular Medicine

Status epilepticus (SE) is one of the most severe neurological emergencies in children. Instead of 30 minutes, modern definitions focus on 5 minutes of continuous seizure activity or recurrent seizures without baseline consciousness due to the high risk of self-perpetuation and neuronal damage [1]. Pediatric status epilepticus can be caused by metabolic abnormalities, structural brain abnormalities, CNS infections, febrile seizures, and idiopathic or cryptogenic causes. Infants and young children are more likely to have the condition because their neurological systems are still maturing, and they are more susceptible to infections and metabolic abnormalities [2]. Due to healthcare access issues, delayed diagnosis, and common infectious causes, SE in children is much higher in low- and middle-income countries, where the worldwide incidence is 10-20 per 100,000 per year. SE management must be done quickly to avoid consequences [3]. Status epilepticus in children poses serious neurological risks, both now and in the future. Excitotoxicity, glutamate overrelease, damages cortex and hippocampus neurones during seizures [4]. Neurological damage is devastating. Cognitive decline, memory loss, and epilepsy risk increase with age. SE can cause low blood oxygen, high body temperature, lactic acidosis, and low blood pressure. These cases often have neuronal injury and multi-organ dysfunction [5]. SE survivors may develop behavioural disorders, developmental delays, or learning disabilities due to structural brain damage or recurrent seizures. Despite treatment advances, paediatric mortality rates range from 3% to 7% depending on the cause and access to timely healthcare [6]. SE-related chronic epilepsy makes life difficult for families [7]. Status epilepticus complications in children are common, making early diagnosis, treatment, and follow-up crucial. SE risk factors and prognostic indicators must be assessed in children to diagnose and treat them quickly. Identifying at-risk populations, managing them well, and predicting outcomes can improve healthcare strategy and resource allocation in similar clinical contexts. Paediatric SE clinical characteristics and outcomes are the focus of this study.

Study design

Descriptive research assessed pediatric status epilepticus risk factors and prognostic indicators. This design studied a specific group of children and performed extensive clinical and diagnostic evaluations to learn as much as possible about the condition's clinical and prognostic aspects.

Study setting

In Kolkata, India, the Vivekananda Institute of Medical Sciences' Paediatric Medicine Department at Ramakrishna Mission Seva Pratishthan conducted this research. This tertiary care facility is known for its pediatric neurological disorder evaluation and treatment resources. The institution's infrastructure enabled EEG and neuroimaging, which were crucial to the study.

Study population

The study population included hospitalized status epilepticus children aged 2 months to 12 years. These children were identified using the operational definition, which included seizures lasting more than five minutes or two seizures without a baseline consciousness return. The participants' ages and socioeconomic backgrounds match hospital patients. The study excluded children with pseudoseizures, seizure mimickers, head trauma, or poisoning to avoid secondary neurological causes.

Ethical approval and consent

The institutional ethics committee approved the study, ensuring it follows human participant research ethics. Parents or legal guardians signed informed consent forms for all enrolled children. By explaining the study's purpose, procedures, and risks, consent was transparent and respectful of participants' autonomy. This ethical approach showed the study's commitment to participant rights and welfare.

Inclusion criteria

Children were eligible for the study if they met the following criteria:

• Age: 2 months to 12 years.
• It is defined as a seizure lasting more than 5 minutes or two discrete seizures with incomplete recovery of consciousness in between.

Exclusion criteria

Children were excluded from the study if they presented with:

• Pseudoseizures or other seizure mimickers.
• History of head trauma.
• Poisoning is a likely etiology for seizure activity.

Sample size

A total of 50 children meeting the inclusion criteria were enrolled in the study.

Data collection

To collect this data, we examined and diagnosed all status epilepticus children. The comprehensive medical history included seizure duration, frequency, and treatment interventions before admission. Physical exams assessed neurological status and seizure-related systemic effects. Laboratory investigations included blood glucose levels, arterial blood gas analysis, and hematological, biochemical, and microbiological studies to determine the causes. We used brain MRIs and CT scans to detect structural abnormalities. We measured brain activity with electroencephalograms. When clinically indicated, urine and CSF analysis were performed to investigate metabolic or infectious causes.

Statical analysis

SPSS or Excel was used to analyze the data. Complications were categorized, and means and standard deviations summarised continuous variables like seizure duration and recovery time. Associations between risk factors and outcomes were assessed using p < 0.05 significance level and statistical tests like t-tests and chi-square analyses. We identified critical risk factors and prognostic indicators for pediatric status epilepticus by systematically collecting and analyzing data.

Demographics and baseline characteristics

Fifty children were enrolled in the study, ranging in age from 2 months to 12 years. The demographic details are summarized below.

Table 1: Demographic and Baseline Characteristics of Study Participants

The age distribution shows a higher incidence in the 3-6 years and 7-12 age groups (40% each), while the male population was more affected (56%). A significant portion of the children (60%) came from lower socioeconomic backgrounds.

Risk factors

The most common predisposing factors for status epilepticus in the study population included infections, metabolic abnormalities, and neurological conditions.

Table 2: Risk Factors for Pediatric Status Epilepticus

Infections, particularly meningitis and encephalitis, were the leading cause (50%), followed by metabolic abnormalities (30%) and neurological disorders (20%).

Clinical presentation

The clinical characteristics of status epilepticus, including the duration and type of seizures, as well as the results of diagnostic tests, were analyzed.

Table 3: Clinical Presentation and Seizure Characteristics in Pediatric Status Epilepticus

The majority of seizures were generalized tonic-clonic (70%), and most seizures lasted longer than 5 minutes (80%). Notably, 24% of the children had abnormal MRI/CT findings, and 30% had abnormal EEG results. Metabolic acidosis was noted in 16% of cases, and hypoglycemia was observed in 10%

Prognostic indicators

Several indicators, including time to seizure control, response to treatment, and imaging/EEG findings, were assessed to evaluate prognosis.

Table 4: Diagnostic Findings in Pediatric Status Epilepticus

Half of patients controlled their seizures in 30 minutes, while the other half took 30–60 minutes. 60% of children responded completely to treatment. EEG and MRI/CT abnormalities were found in 30% and 24% of cases, respectively.

Outcomes

The outcomes measured in the study included neurological recovery, complications, and mortality rates.

Full neurological recovery occurred in 80% of children. The children had 10% cognitive impairments and 6% developmental delays. Two children died from complications despite intensive treatment, raising the mortality rate to 4%.These findings illuminate clinical characteristics, risk factors, prognostic indicators, and outcomes of paediatric status epilepticus to improve management and prognosis.

Interpretation of the study

This study describes paediatric status epilepticus (SE) clinical features, risk factors, and prognostic indicators. SE was most common in children aged 3 to 12 (80%), consistent with previous research of SE in younger and middle-aged children. This discovery is noteworthy. Our findings support previous research that men are more likely to experience SE than women, as 56% of participants were men. In our study, 50% of risk factors were infections, especially meningitis and encephalitis. Metabolism abnormalities were second at 30%. This supports previous findings that metabolic disturbances and infections cause SE in children. Feverish and critically ill children must be diagnosed quickly because meningitis and encephalitis greatly increased SE in our cohort. Generalized tonic-clonic seizures are the most common SE in children, and this study confirms this (70%). Eighty percent of seizures lasted longer than five minutes, suggesting delayed intervention may worsen outcomes. This confirms the well-established theory that longer SE increases the risk of neurological complications and death.

Time to seizure control was a key prognostic factor. Children who controlled their seizures within 30 minutes (50%) had a better chance of neurological recovery, emphasising the importance of early intervention in avoiding long-term effects. In addition, 60% of the children responded fully to treatment, indicating a good outcome. This shows that barbiturates, benzodiazepines, and phenytoin work for SE in children. Our results confirm previous research that abnormal EEGs are associated with a poor prognosis, suggesting that they often indicate more serious pathology and worse long-term outcomes.Instead of the typical 7% mortality rate in paediatric SE studies, our study found 4%. However, other studies show that if seizures are controlled quickly, recovery is possible, and the neurological recovery rate of 80% is consistent.

Comparison of Findings with Existing Literature

This study adds to the pediatric status epilepticus (SE) literature. Our gender preference and age distribution results match previous studies. Our findings support the literature that boys under 12 make up a disproportionate share of pediatric SE cases. [8] found that 5–10-year-old boys and girls have the most SE. A complex interaction of hereditary, hormonal, and environmental factors may explain why men have more seizures. This study confirmed previous findings that metabolic abnormalities and infections (including meningitis and encephalitis) were major risk factors. Infections have long been a major cause of pediatric SE. [9] found that infections, particularly bacterial meningitis and viral encephalitis, caused SE in their cohort. Metabolic disturbances like hypoglycemia and electrolyte imbalances cause SE in children. Our study found metabolic causes in 30% of cases, supporting this. Compared to other studies, 70% of patients in this study had generalized tonic-clonic seizures. [10] found that 60–80% of SE children had generalized tonic-clonic seizures. Our finding that 80% of SE cases had seizures lasting five minutes or more is consistent with previous research since long seizures are typical of SE and increase the risk of neurological damage and negative outcomes [11].

Implications for clinical practice

This study has major clinical implications. Blood, imaging, and CSF analysis must be done immediately and thoroughly on SE-presenting children. Because infection and metabolic abnormalities are major risk factors. Early root causes identification allows more targeted treatment, which may improve outcomes. Controlling seizures quickly prevents neurological damage. The results show that seizure control within 30 minutes improves neurological outcomes. This suggests that paediatric SE management requires prompt anticonvulsant medication administration. One cannot overstate the importance of EEG and brain imaging in prognosis. Children with SE have a high rate of abnormal EEG findings, so EEG monitoring is always needed to detect pathology and aid in treatment. Like abnormal MRI/CT scans, structural lesions may need special treatment. A low death rate in this study suggests a good prognosis for paediatric SE if treated quickly. For optimal patient outcomes, rapid response protocols and clinical guidelines are essential.

Strengths

The research was ethically approved by the institution and parental consent was obtained. This lends data and findings credibility. Blood, imaging, and EEG tests were used to understand paediatric SE's causes. This extensive data collection allows for more detailed prognostic indicator analysis.

Limitations

Small sample size (50 children) may limit generalisability. Larger cohorts could have revealed more risk factors and warning signs and improved statistical analysis. The study was conducted by one institution, so results may be limited. Results may not apply due to healthcare access, patient populations, and institutional protocols. Due to the descriptive study, causal relationships between risk factors and outcomes may be impossible. Prospective studies are needed to confirm results and investigate causal pathways. Finally, the study's pediatric status epilepticus risk factors, prognostic indicators, and clinical outcomes are valuable. Results emphasize the importance of prompt diagnosis and treatment, especially for seizure duration and origins. Despite its limitations, the study adds to the evidence base for pediatric SE treatment and suggests future research.

Early diagnosis of status epilepticus in children reduces the risk of neurological issues and death. This study confirmed previous findings that infections and metabolic disturbances are major risk factors for SE in children. Rapid seizure control and normal EEG/brain imaging predicted better outcomes. Our study found that early intervention and management greatly improved neurological recovery. When treatment was delayed, EEGs were abnormal, or brain imaging was abnormal, kids did worse. Although the cohort's mortality rate was low at 4%, children with long-term seizures and abnormal diagnostic results suffered long-term cognitive and developmental delays. This study emphasises the need to address paediatric SE quickly and forcefully. Additional research into optimizing diagnostic protocols and management strategies is needed to improve impacted children's prognoses. Healthcare providers must recognise the importance of timely intervention and identify predictive factors to improve paediatric SE outcomes.

1. Specchio, N., Pietrafusa, N., Bellusci, M., Trivisano, M., Benvenga, A., de Palma, L., ... & Vigevano, F. (2019). Pediatric status epilepticus: Identification of prognostic factors using the new ILAE classification after 5 years of follow‐up. Epilepsia, 60(12), 2486-2498.
2. Sculier, C., Gaínza‐Lein, M., Sánchez Fernández, I., & Loddenkemper, T. (2018). Long‐term outcomes of status epilepticus: a critical assessment. Epilepsia, 59, 155-169.
3. Gaínza‐Lein, M., Barcia Aguilar, C., Piantino, J., Chapman, K. E., Sánchez Fernández, I., Amengual‐Gual, M., ... & Pediatric Status Epilepticus Research Group. (2021). Factors associated with long‐term outcomes in pediatric refractory status epilepticus. Epilepsia, 62(9), 2190-2204.
4. Jafarpour, S., Stredny, C. M., Piantino, J., & Chapman, K. E. (2019). Baseline and outcome assessment in pediatric status epilepticus. Seizure, 68, 52-61.
5. Renda, R., Yüksel, D., & Gürer, Y. Y. (2020). Evaluation of patients with febrile seizure: Risk factors, reccurence, treatment and prognosis. Pediatric emergency care, 36(4), 173-177.
6. Valton, L., Benaiteau, M., Denuelle, M., Rulquin, F., Le Camus, C. H., Hein, C., ... & Curot, J. (2020). Etiological assessment of status epilepticus. Revue neurologique, 176(6), 408-426.
7. Gurcharran, K., & Grinspan, Z. M. (2019). The burden of pediatric status epilepticus: epidemiology, morbidity, mortality, and costs. Seizure, 68, 3-8.
8. Sartori, S., Nosadini, M., Tessarin, G., Boniver, C., Frigo, A. C., Toldo, I., ... & Da Dalt, L. (2019). First‐ever convulsive seizures in children presenting to the emergency department: risk factors for seizure recurrence and diagnosis of epilepsy. Developmental Medicine & Child Neurology, 61(1), 82-90.
9. Pellerino, A., Caccese, M., Padovan, M., Cerretti, G., & Lombardi, G. (2022). Epidemiology, risk factors, and prognostic factors of gliomas. Clinical and Translational Imaging, 10(5), 467-475.
10. Smith, D. K., Sadler, K. P., & Benedum, M. (2019). Febrile seizures: risks, evaluation, and prognosis. American family physician, 99(7), 445-450.
11. Canpolat, M., Per, H., Gumus, H., Elmali, F., & Kumandas, S. (2018). Investigating the prevalence of febrile convulsion in Kayseri, Turkey: An assessment of the risk factors for recurrence of febrile convulsion and for development of epilepsy. Seizure, 55, 36-47.