Clinical and EEG characteristics, etiologies, treatment response, and predictors of long-term outcome were determined in 154 children with status epilepticus (SE) hospitalized at the Mayo Clinic, Rochester, MN, 1994-2004. Patients with status aborted with medication (ASE) in 69% were compared to 39% with refractory SE (RSE). SE was defined as continuous tonic-clonic or electrographic seizure activity for at least 10 min or intermittent seizure activity without recovery of consciousness for at least 30 min [1]. Etiology of SE was acute symptomatic in 26%, remote symptomatic 35%, idiopathic 20%, and febrile in 10%. RSE compared to ASE was significantly associated with a higher family history of seizures, higher number of seizures and AEDs, nonconvulsive SE, and focal or electrographic seizures on initial EEG. In-hospital mortality was significantly higher with RSE (13.3%) than ASE (2.1%). RSE patients developed more neurological deficits and more epilepsy at long-term follow-up than ASE children. More aggressive treatment resulted in better responses and outcomes. Poor outcome risk factors included long seizure duration, acute symptomatic etiology, nonconvulsive SE, and young age (<5 years) at admission. Prospective, randomized trials of different treatment protocols are advocated. [2]

COMMENT. Status epilepticus in children is refractory in 40%, and RSE is related to family history, number of seizures and AEDs, nonconvulsive status, and initial EEG abnormalities. Etiology is an important determinant of outcome, especially acute symptomatic causes. Identification of these risk factors should lead to more aggressive therapy and better outcome.