The occurrence of status epilepticus (SE) after the initial diagnosis of epilepsy was determined in a prospective community-based cohort study of 613 children at Montefiore Medical Center, Bronx, NY; Yale Medical School, New Haven, CT; and BIOS/NIU, DeKalb, IL. During a median follow-up of 8 years, 58 (9.5%) had 1 or >1 episode of SE, the first occurring a median of 2.5 years after initial diagnosis (range, <1 month to 8.8 years). Thirty three had only one episode, 8 had 2 episodes, and 16 had 3 or more episodes. Of 56 patients with previous SE, 18 (32.1%) had at least one further episode during follow-up compared to 40 of 557 (7.2%) without history of SE (P<0.0001). Factors associated with a risk of SE included SE before initial diagnosis of epilepsy, younger age at onset (3 fold increased risk at age <1 year vs 10+ years) and symptomatic etiology. In those with no SE before initial diagnosis, the risk of SE during follow-up was 14% in the symptomatic etiology group vs 2.6% in the idiopathic group. In those with previous SE, the relative risks for symptomatic/idiopathic groups were 52% vs 37%. Overall, 13 (2.1%) died, and the risk of dying was greater in children who had previous SE (5/56 [8.9%]) vs 8/557 [1.4%] who did not (P=0.0002). Death in those with previous SE was usually associated with an underlying cause, eg neurodegenerative or encephalopathic disorder. Children who experienced SE during follow-up were less likely to be in 3-year remission (19.6% vs 65.3%; P<0.0001) and much more likely to have intractable seizures (47.4% vs 8.9%; P<0.0001). [1]

COMMENT. The risk of status epilepticus (SE) in children with an initial diagnosis of epilepsy is approximately 10%. The risk is increased in children with a previous history of status, in younger age groups, and in those with symptomatic etiology. Data regarding antiepileptic drug levels in patients with SE would be of interest. The authors recommend abortive therapy in the home for patients at high risk of SE. A poor outcome of SE in a Netherlands study was related to inadequate AED therapy, as well as medical complications (eg respiratory insufficiency, cardiac arrhythmias), and a duration of SE greater than 4 hours [2]. Noncompliance with antiepileptic drug therapy or inadequate instruction regarding the use of rectal diazepam in the home were the explanations for the admission of 8 children with SE at the University Hospital of Wales, Cardiff, UK. [3]

In a previous study by the current group of authors, SE was the first seizure in 38 (11%) of 342 children followed for a mean of 72 months after a first idiopathic unprovoked seizure (Shinnar S, et al. Dev Med Child Neurol 1995;37 (suppl 72): 116 (abstract)). At follow-up, 127 (37%) had experienced a seizure recurrence, including 42% of those who presented with status and 37% of those with a brief first seizure. SE did not adversely affect outcome in this cohort of idiopathic cases. The importance of seizure prevention or abortive therapy is stressed in both US and UK literature, especially in symptomatic epilepsies.