Clinical characteristics of status epilepticus in children in a third level hospital of Lima
DOI:
https://doi.org/10.20453/rnp.v85i4.4367Keywords:
Epilepsy, children, status epilepticus, etiology, generalized motor pictureAbstract
Status Epilepticus (SE) in children exhibits high levels of morbidity and mortality and has been poorly studied in Perú. Objective: To describe the frequency and clinical characteristics of children with Status Epilepticus treated at Cayetano Heredia Hospital in Lima. Material and Methods: Retrospective and observational study, case series type, in children under 14 years of age, with Status Epilepticus treated between January and December of 2021. Results: SE was recorded in 28.8% of children with epileptic seizures seen during 2021. Twenty-three children presenting 46 SEs were included. The median age was 2 years, the majority (73,9%) being males, with diagnosis of epilepsy or brain malformation (21.7%) and treated in the pediatric emergency (91%). The predominant semiological pattern was of generalized motor type (52.2%), with remote symptomatic etiology (73.9%), and EEG recorded in a 63% of all cases, mainly reported as normal (75,9%). The median duration was 22 minutes of total resolution, 7 minutes, and of partial resolution, 2 minutes. Midazolam was used as the first line of treatment (78%), and phenytoin as the second line (85%). Conclusions: SE was a frequent condition observed in children throughout the year 2021. Most affected children were male, the predominant etiology was remote symptomatic, and the most common semiological type was the generalized motor. The children were treated according to international management guidelines. A systematic epidemiological surveillance approach is highly encouraged.
References
Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia.2015;56(10):1515-23. DOI: 10.1111/epi.13121
Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Epilepsia. 1993;34(4):592-6. DOI: 10.1111/j.1528-1157.1993.tb00433.x
Walker MC. Pathophysiology of status epilepticus. Neurosci Lett. 2018; 667:84-91. DOI: 10.1016/j.neulet.2016.12.044
Gurcharran K, Grinspan ZM. The burden of pediatric status epilepticus: Epidemiology, morbidity, mortality, and costs. Seizure. 2019;68:3-8. DOI: 10.1016/j.seizure.2018.08.021
Placencia M. Incidencia, prevalencia y magnitud global de las epilepsias en America Latina y el Caribe. En: Campos M. Epilepsias Diagnóstico y tratamiento. Santiago de Chile: Mediterraneo; 2002. p. 49-66.
Oliva O, Ochoa X. Fiesta neuronal: estado epileptico en pediatría. An Med. 2018; 63(1):38-47.
Castellanos RG, Barrios Peralta E, Suarez J, Narino D. Enfoque del estatus epileptico en adultos: consideraciones sobre la fisiopatología y tratamiento. Acta Neurol Colomb. 2017;33(3):199-210. DOI: 10.22379/24224022157
Guillen-Pinto D, Gonzales CV, Vidal W, Santivafiez C, Vila J, Juárez T, et al. Epilepsia en niños atendidos en el Hospital Nacional Cayetano Heredia de Lima, Peru, 2010- 2016: Rev Neuro-Psiquiatr. 2018;81(4):217-25. DOI: 10.20453/rnp.v81i4.3436
Argandofia JM, Romero UA. Características clínicas de la primera crisis epileptica en nifios que acuden al Hospital Cayetano Heredia. Tesis de Grado. Lima: Universidad Peruana Cayetano Heredia; 2021. (Citado 18 de mayo de 2022). Disponible en: https://repositorio.upch.edu.pe/handle/20.500.12866/9587
Peralta Hidalgo RE. Características clínicas y epidemiológicas de la epilepsia infantil en el Hospital San Juan Bautista de Huaral durante el período2015 - 2019. Tesis de Grado. Lima: Universidad Peruana Cayetano Heredia; 2019. (Citado 31 de mayo de 2022). Disponible en: https://repositorio.upch.edu.pe/handle/20.500.12866/7035
Araneda Y, Eduardo M. Aspectos etiopatogeneticos y clínicos de la epilepsia infantil. Tesis para optar el grado de bachiller en medicina. Trujillo: Universidad Nacional de Trujillo; 2017.
Oficina de Estadística e Informática. Indicadores para la Evaluación 2018: UPSS Emergencia. Lima: Hospital Cayetano Heredia; 2018. (Citado 21 de agosto de 2020). Disponible en:
http://www.hospitalcayetano.gob.pe/PortalWeb/wp-content/uploads/2019/04/CUADROS_ EMERGENCIA_2018.pdf
Yasiry Z, Shorvon SD. The relative effectiveness of five antiepileptic drugs in treatment of benzodiazepine- resistant convulsive status epilepticus: a meta-analysis of published studies. Seizure. 2014;23(3):167-74. DOI: 10.1016/j.seizure.2013.12.007
Dalziel SR, Borland ML, Furyk J, Bonisch M, Neutze J, Donath S, et al. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. Lancet Lond Engl.2019;393(10186):2135-45. DOI: 10.1016/S0140-6736(19)30722-6
Smith D, McGinnis E, Walleigh D, Abend N.Management of Status Epilepticus in Children. J Clin Med. 2016;5(4):47. DOI: 10.3390/jcm5040047
Singh A, Stredny CM, Loddenkemper T. Pharmacotherapy for Pediatric Convulsive Status Epilepticus. CNS Drugs. 2020;34(1):47-63. DOI: 10.1007/s40263-019-00690-8
Buompadre MC. Estado de Mal Epileptico. Medicina (Buenos Aires). 2018;78(2):12-7.
Vargas LCP, Varela EX, Kleinsteuber SK, Cortes ZR, Avaria BM. Revisión del estado epileptico convulsivo pediátrico y su manejo antiepileptico. Rev Medica Chile. 2016;144(1):83-93. DOI: 10.4067/S0034-98872016000100011
Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia.2010; 51(4):671-5. DOI: /10.1111/j.1528-1167.2009.02285.x
Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality: First Seizure Definitions, Incidence, Mortality. Epilepsia.2008;49:8-12. DOI: 10.1111/j.1528-1167.2008.01443.x
Ramos-Argüelles F, Morales G, Egozcue S, Pabón RM, Alonso MT. Tecnicas básicas de electroencefalografía: principios y aplicaciones clínicas. Sist Sanit Navar. 2009;32:14.
Kuroda N. Epilepsy and COVID-19: Updated evidence and narrative review. Epilepsy Behav. 2021;116:107785. DOI: 10.1016/j.yebeh.2021.107785
Ayrampo WM, Cabrera ARJ. Plan Maestro del Hospital Nacional Cayetano Heredia. Desarrollo de infraestructura física, equipamiento y RR.HH (2009-2018). Lima: Ministerio de Salud; 2009.
Medina P. Síndrome de West, el desafío de una atención oportuna. Rev Neuro-Psiquiatr. 2015;78(2):63-4.
Gutierrez-Tudela JW. La pandemia de la COVID-19 en el Peru: análisis epidemiológico de la segunda ola. Rev Soc Peru Med Interna. 2021;34(4):129-129. DOI: 10.36393/spmi.v34i4.627
Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet.2006;368(9531):222-9. DOI: 10.1016/ S0140-6736(06)69043-0
Lambrechtsen FACP, Buchhalter JR. Aborted and refractory status epilepticus in children: A comparative analysis. Epilepsia. 2008;49(4):615-25. DOI: 10.1111/j.1528-1167.2007.01465.x
Aránguiz J, Hernandez-Chavez M, Escobar R, Mesa T. Childhood epilepsy status in a university hospital: A descriptive study. Rev Neurol. 2008;47:286-90.
Otero LP, Herrera YA, Cornejo JW, Carrizosa J, Henao J. Estado epileptico en nifios: experiencia de un hospital de alta complejidad en Medellín, Colombia. Acta Neurológica Colomb. 2019;35(3):123-9.
Kravljanac R, Djuric M, Jankovic B, Pekmezovic T.Etiology, clinical course and response to the treatment of status epilepticus in children: A 16-year single- center experience based on 602 episodes of status epilepticus. Eur J Paediatr Neurol. 2015;19(5):584-90. DOI: 10.1016/j.ejpn.2015.05.007
Arce-Portillo E, Rufo-Campos M, Munoz-Cabello B, Blanco-Martinez B, Madruga-Garrido M, Ruiz-Del Portal L, et al. West syndrome: aetiology, therapeutic options, clinical course and prognostic factors. Rev Neurol.2011;52(2):81-9.
Larsen J, Carvill GL, Gardella E, Kluger G, Schmiedel G, Barisic N, et al. The phenotypic spectrum of SCN8A encephalopathy. Neurology. 2015;84(5):480-9.
Scheffer IE, Nabbout R. SCN1A-related phenotypes:Epilepsy and beyond. Epilepsia. diciembre de 2019;60 Suppl 3:S17-24.
Zaman T, Helbig KL, Clatot J, Thompson CH, Kang SK, Stouffs K, et al. SCN3A-Related Neurodevelopmental Disorder: A Spectrum of Epilepsy and Brain Malformation. Ann Neurol. 2020;88(2):348-62. DOI: 10.1002/ ana.25809
Departamento de Pediatría del Hospital Cayetano Heredia, Departamento de Emergencia y Cuidados Pediátricos. Protocolo de diagnóstico y tratamiento de estado epileptico en nifios. Lima: Hospital Cayetano Heredia; 2018. pp.3-33 .
Zimmern V, Korff C. Status Epilepticus in Children.J Clin Neurophysiol. 2020;37(5):429-33. DOI: 10.1097/WNP.0000000000000657
Lyttle MD, Rainford NEA, Gamble C, Messahel S, Humphreys A, Hickey H, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet Lond Engl. 2019;393(10186):2125-34. DOI: 10.1016/S0140-6736(19)30724-X
Saz EU, Karapinar B, Ozcetin M, Polat M, Tosun A, Serdaroglu G, et al. Convulsive status epilepticus in children: Etiology, treatment protocol and outcome. Seizure - Eur J Epilepsy. 2011;20(2):115-8. DOI: 10.1016/j.seizure.2010.10.034