Clinical study Determinants of mortality and long-term outcome in children with refractory and super refractory status epilepticus

Aim: To evaluate factors associated with progression of convulsive refractory status epilepticus(RSE) to super refractory status epilepticus(SRSE) and long term outcome in children. Materials and methods: In this open cohort study, data of children admitted with convulsive RSE from 2010 to 2018 was retrospectively analyzed. The outcome at two years was graded according to the Glasgow outcome scale(GOS). Results: Fifty six children formed study population, 24 progressed to SRSE. The mean age of the study population was 9.38 +/- 4.28(2-16) years. There was no significant difference for age between SRSE and RSE children (9.53 +/- 4.50 years vs. 9.17 +/- 4.06 years; p = 0.756). Acute symptomatic aetiology was the most common aetiology for RSE (57.1%) and SRSE (54.2%). There were no differences for aetiology between children who progressed to SRSE and those who did not. Mean length of stay in the NICU was 13.54 +/- 17.53 days and children who progressed to SRSE had a longer length of stay in NICU (4.78 +/- 3.03 days vs. 25.21 +/- 21.77 days; p < 0.001). The mortality was 14.2%. Acidosis was more common in children who died (27.1% vs. 87.5%;p < 0.001). There was no significant difference in the mortality between RSE and SRSE (9.4% vs. 20.8%; p = 0.268). At latest follow up 34 (60.7%) children had good outcome. Poor outcome was more common in children who progressed to SRSE(29.4% vs. 63.6%;p < 0.015). Conclusion: Acute symptomatic etiology is more frequent in children with RSE and SRSE. Progression to SRSE did not significantly increase mortality but associated with poor GOS outcome. Encouragingly, 60% of children had good outcome.