A retrospective analysis indicates that children with seizures who develop status epilepticus show differences in certain clinical features, compared to those with seizures but without status epilepticus.
SAVANNAH, GA—Clinical features, such as multiple seizure types and developmental delay, of pediatric patients admitted to the hospital for seizures may help to predict the risk of status epilepticus, according to research presented at the 40th National Meeting of the Child Neurology Society.
Led by Martina Vendrame, MD, PhD, Assistant Professor of Neurology at the Boston University School of Medicine, a team of investigators conducted a retrospective analysis of 1,291 medical records for seizure admissions at Children’s Hospital Boston. The researchers sought to identify the clinical features of patients at risk for status epilepticus and to find status epilepticus predictors in children who were hospitalized for seizures.
Clinical features of patients with a history of status epilepticus were compared to the clinical features of patients with no history of status epilepticus. The Wilcoxon test was used to perform statistical analysis, and chi-square tests and odds ratio were calculated when appropriate.
Describing Clinical Features
According to hospital records, 1,291 patients (54% male) with a median age of 28 months were admitted to the hospital with seizures. The researchers found that the children had a variety of clinical features, with some children exhibiting more than one characteristic. Overall, 553 (42.8%) patients had one seizure type, 738 (57.1%) had multiple seizure types, 553 (42.8%) had developmental delay, 280 (21.7%) had abnormal EEG results, and 568 (44%) had abnormal MRI results. There were 669 children who were admitted multiple times to the hospital. Furthermore, 770 children (62%) were on fewer than two antiepileptic drugs (AEDs), and 491 children were on two or more AEDs.
Differences Between Patients
Overall, the researchers identified 458 (35.5%) children with a history of status epilepticus and 833 (64.5%) with no history of status epilepticus. A comparison of the two groups showed several distinctions in clinical features between the patients.
Dr. Vendrame told Neurology Reviews that children with a history of status epilepticus were more likely to have multiple types of seizures (odds ratio [OR], 2.77), which was the most significant clinical predictor identified. “If a child has more than one seizure type—generalized and focal, for example—then he or she is at higher risk of status epilepticus,” she said. “We estimated that the risk is about twofold higher in this case.”
In addition, children with a history of status epilepticus showed a greater tendency to have developmental delay (OR, 1.62), prior EEG abnormalities (OR, 1.52), MRI abnormalities (OR, 1.56), and multiple hospital admissions (OR, 2.01). They were also likely to be taking more AEDs (OR, 1.72).
“These identified differences may contribute to predicting status epilepticus risk in hospitalized pediatric epilepsy patients,” Dr. Vendrame’s group wrote. However, the researchers cautioned against drawing conclusions from their retrospective analysis, as future prospective studies will be necessary to identify biomarkers for status epilepticus in children with epilepsy. According to Dr. Vendrame, investigators might find biomarkers such as specific brain lesions viewed by MRI or specific EEG abnormalities that could indicate the risk of status epilepticus.
“Understanding the risk factors for status epilepticus will help us to design treatment plans and manage care limiting these risk factors, resulting in prevention of status epilepticus,” said Dr. Vendrame. “Given that occurrence of status epilepticus is estimated to be about 17 to 23 per 100,000 children annually with mortality estimates ranging between 2% and 21.2%, the implications of knowing and addressing status epilepticus risk factors are enormous.”
—Lauren LeBano