Definition (Neurology 2006;67:1542)
• Min duration of 30 min or ≥2 sequential szrs w/o consciousness btw szrs
• Initiate treatment after 5 min for impending SE
Epidemiology (Lancet 2006;368:222; Epilepsia 2007;48:1652; Neurology 2010;74:636)
• Incidence ∼20/100,000 children per yr. If hx of epilepsy, risk incr 9.1–27%
• 60% of affected children were previously neurologically healthy
• First presentation of epilepsy in ∼10% of children
• Risk factors include hx of clustered focal seizures or prior SE, focal EEG abnl,
neuroimaging abnl, and <1 yo
Etiology (Neurology 2006;67:1542)
• Acute symptomatic: More common in younger kids/infants, during acute illness. Etiology: Meningitis, encephalitis, electrolyte abnl, sepsis, hypoxia, trauma, intox
• Remote symptomatic: Occurs w/o acute trigger and in pt w/ prior CNS insult Etiology: CNS malform, prior TBI or insult, chromosomal disorder
• Febrile: No direct CNS infxn. Etiology: e.g., URI, gastroenteritis, sinusitis, sepsis
• Progressive encephalopathy: Underlying progressive CNS disorder. Includes mitochondrial disorders, CNS lipid storage diseases, amino/organic acidopathies
• Idiopathic: No definable cause
Diagnostic Workup (Neurology 2006;67:1542; Pediatr Rev 2007;28:405)
• Labs: Finger glucose, CBC, Chem10. Consider urine and blood cxs. LP if suspicion of CNS infection. Consider serum and urine tox and/or studies for inborn errors of metabolism and genetics if history suggestive or etiology unclear. Check AED levels for pts w/ epilepsy on AED prophy
• EEG: Consider if child p/w new onset or non-convulsive SE
• Neuroimaging: Consider if suspect ↑ ICP, focal deficits, or if unknown etiology
Treatment (Pediatr Rev 2007;28:405)
• ABCs: O2 by mask, CV monitor. IV. Correct metabolic abnl. Monitor for resp depression
• For children < wk old: No universal protocols. The protocol at our institution:
• For children > 4 wk old:
Note: Levetiracetam 20 mg/kg IV often used in clinical practice, though there is little data.
Complications (Lancet Neurol 2006;5:769)
• Include hypoxemia, acidosis, hypo/hyperglycemia, ↑ ICP, vascular changes
• Mortality ∼5%; excess metab demand → O2 insuff and neuronal damage/necrosis
• Morbidity <15% for neurological sequelae, often 2/2 underlying cause of SE