Explore The Clinical Features And Prognostic Correlation Factors Of 207 Children With Convulsive Status Epilepticus

objective: To Explore the clinical features and the correlation factors that influence the prognosis of convulsive status epilepficus(CSE)in children,and providing the theoretical evidence for diagnosis, treatment and prognosis judgement.Methods: The database of 207 children with CSE diagnosed in hospital from June 2005 to June 2008 was reviewed, retrospectively analysis included: sex, age of onset, etiology, history of convulsion, duration, head imaging examination, EEG, presence of fever, diagnosis, treatment and course in hospital, and study these factors on the impact of short-term prognosis in children; of which 138 cases were followed up, study these factors on the impact of long-term prognosis and recurrence.Results:(1) A total of 207 children had CSE. The sex ratio of male:female was 1.11:1. In this study, the age of onset of CSE varied from 1 month to 15 years with a peak age ranged from 1 to 3 years (N=74;36%), the mean age is 37 months. The etiologies of 207 cases included: acute symptomatic (N=77;37%); epilepsy(N=60;29%); remote symptomatic(N=37;18%); Complex febrile seizures(N=19;9%); unclassified(N=14; 7%). The most common cause of CSE in children was acute symptomatic.(2) 79(38%) of the 207 cases had history of convulsion, 48(60%)of 79 cases had a prior diagnosis of epilepsy. 18(37.5%)of 48 cases had fever, their CSE were induced by infections, 20(41%)were induced by irregular anti-epileptic treatment, of which 4 (8.33%) patients were induced by suddenly withdraw of AEDs. Fever caused by infection and irregular anti-epileptic treatment were the most common motivation of CSE in epilepsy. However, most children with CSE (N=128;62%) hadn't history of. convulsion.(3) Of the 207 children with CSE, the shortest duration of convulsion was 30min, the longest duration was 30 days(median 2h), including within 1 hour (N=85;41%), within 24 hours (N=74;36%), More than 24 hours (N=48;23%). Duration had relationship with etiology, CSE caused by acute symptomatic had the longest duration, and complex febrile convulsion had the shortest duration.(4) Of the 207 children with CSE, 111(54%)children had presence of fever; 129(62%)children had abnormal EEG; 68(33%)children had abnormal head imaging; 16(22%)children had abnormal cerebrospinal fluid; 22(10.6%)children had hyponatremia; 9(4.5%)children had abnormal liver function. (5) Of the 207 children with CSE, 101(49%)discharged curing; 71(34%)discharged improving; 30(14.5%)discharged giving up the active treatment; 5(2.4%) had dead. 138(67%)were followed up successfully, of the 138 cases ,44(32%)hadn't recurrence of convulsion and needn't long-term anti-epileptic treatment.;47(34%)had recurrence of convulsion, 59(43%)had neurologic sequela; 16(12%) had dead.Conclusions:(1) CSE could occure in children of any age,but mostly in 1-3 years; incidence had no significant difference between male and female. The etiology of CSE in children was Complex, however, the main etiology of CSE in children was acute symptomatic and accounted of 37%, followed by epilepsy and remote symptomatic. Etiology had age-related, children with CSE aged below 3 years was mainly induced by acute symptomatic, but in children aged more than 3 years , epilepsy is relatively common.(2) Most children with CSE hadn't history of convulsion. Of which had history of convulsion,60% was epilepsy, fever caused by infection and irregular anti-epileptic treatment were the most common induction of CSE with epilepsy. Of the 207 cases, 12(5.8%)patients developed de novo epilepsy. Duration had distinct relationship with etiology, Most children which induced by complex febrile seizures had the shertest duration of﹤1 hour,but CSE with duration of﹥24 hours mainly induced by acute symptomatic cause. (3) The overall improve-cure rate was 82% ,and the overall mortality was 10%,the incidence of neurologic sequelae was 43%.The short-term prognosis of CSE was found to be strongly associated with duration and the presence of fever, CSE lasting longer than 1 hour and CSE with presence of fever had the poor outcome. The long-term prognosis of CSE was mainly associated with etiology, history of convulsion and head imaging examination, CSE with symptomatic cause, CSE which had abnormal head imaging and had history of convulsion had the poor outcome. Recurrence of convulsion in children with CSE was most commonly founded in cases with remote symptomatic cause and epilepsy.