The etiology and outcome of status epilepticus (SE) in 135 children (76 boys, 59 girls), ages 1 month to 15 years, admitted to Nemazee Hospital, Shiraz, Iran, between 1999 and 2004, were studied retrospectively, and outcomes were rated according to the Glasgow Outcome Score (GOS). The mean +/- SD age was 4.14+/-3.8 years; 44 (33%) were younger than 12 months, 29 (21%) were 1-3 years old, and 62 (46%) were older than 3 years. Prolonged febrile seizure was the etiology in 69 (51%); 57% of FS patients were <12 months old, 45% 1-3 years, and 50% >3 years. Idiopathic SE accounted for a total of 50 (37%) cases, and was associated with discontinuation of anticonvulsant drug in 38 (28%). Symptomatic SE was the cause in 16 (11.9%); 10 due to CNS infection, 4 metabolic disorders, and 2 trauma-related. Etiology did not differ significantly between age groups (P=0.736) or sex (P=0.156).

Fourteen (10.4%) died in hospital, and 81 (60%) were discharged well. Death was related to a prolonged febrile seizure in 4, idiopathic SE in 6, and symptomatic CNS infection in 3. Patients with symptomatic SE had the worst outcome, with 63% morbidity and mortality; the morbidity and mortality rate was 48% in idiopathic SE cases, and 29% for febrile seizure SE cases. Mean +/- SD duration of hospitalization was 7+/-9.7 days (range, 1-68 days); it did not differ with etiology but was shorter for patients with good outcome. [1]

COMMENT. Fever is the most common cause of status epilepticus (SE) in children, even in those older than 3 years. The etiology of SE is significantly correlated with the outcome, symptomatic cases secondary to CNS infection having the worst, and prolonged febrile seizures the most favorable outcome. Factors in outcome of SE in adolescents and adults in the Netherlands were the underlying cause, noncompliance with AED treatment, systemic infection, and duration of the SE [2]. Noncompliance with AED therapy or inadequate instruction regarding the use of rectal diazepam administered in the home explained the need for admission of children with SE in a study in the UK. [3]

The risk of SE in children with an initial diagnosis of epilepsy is 9.5%, according to a prospective community-based cohort study of 613 children in New York [4]. The risk is increased in children with a previous history of SE, in younger age groups, and in those with symptomatic etiology. The risk was 14% in symptomatic cases and 2.6% in the idiopathic group. The authors agree with the UK practice, recommending abortive therapy (rectal diazepam) in the home for patients at high risk of SE. The importance of seizure prevention and early abortive therapy is stressed, especially in symptomatic epilepsies. A clear predetermined plan of action, prompt administration of appropriate AEDs in adequate doses, and attention to apnea, hypoventilation, fever and infection, or metabolic abnormalities are outlined by the Epilepsy Foundation of America’s working group on SE. [5]