Annals of Indian Academy of Neurology
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Year : 2007  |  Volume : 10  |  Issue : 5  |  Page : 7-18

Convulsive status epilepticus in children

Neurosciences Unit, UCL-Institute of Child Health, London; Epilepsy Unit, Great Ormond Street Hospital for Children NHS Trust, London; The National Center for Young People with Epilepsy, Lingfield, United Kingdom

Correspondence Address:
Rod C Scott
Neurosciences Unit, UCL - Institute of Child Health. The Wolfson Center, Mecklenburgh Square, London WC1N 2AP
United Kingdom
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Source of Support: None, Conflict of Interest: None

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Convulsive status epilepticus (CSE) is the most common neurological emergency in childhood. It differs from adult CSE in aspects of epidemiology, pathophysiology and clinical presentations, which justifies a separate analysis. The incidence is 18-20/100,000 children/year and distribution of aetiologies is markedly age-dependent: Febrile and acute symptomatic CSE are most common in children aged <2 years, whereas cryptogenic-idiopathic and remote symptomatic aetiologies are more common in older children. Mortality is 3-5% and morbidity directly attributable to CSE is less than 15%. When compared to brief seizures, the incidence of subsequent epilepsy is increased only in symptomatic goups. Aetiology is the main determinant of outcome, while the separate effect on outcome of duration, age and treatment remains controversial. The risk of sequelae in unprovoked and febrile CSE is low. There is some evidence that CSE, especially febrile CSE, might cause hippocampal injury, although its role in the development of mesial temporal sclerosis remains uncertain. Prolonged seizures lasting over 5-10 minutes are unlikely to stop spontaneously and should be treated as CSE. Prehospital administration of benzodiazepines is safe and simplifies subsequent management of CSE in the hospital setting. Treatment includes resuscitation measures, identification and treatment of causal factors and early antiepileptic treatment following local guidelines that may be based on national guidelines.

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