Status Epilepticus Associated with Significant Mortality and Cost


PURPOSE: To summarize the epidemiology, morbidity, mortality, and costs of status epilepticus (SE) in the pediatric population.

METHOD: Review of the medical literature.

RESULTS: The overall incidence of pediatric SE is roughly 20 per 100,000 children per year, with overall mortality of 3%. Underlying etiology is the biggest risk factor for SE, with symptomatic (acute > remote) etiologies associated with worse outcomes. The most common cause of SE in children is febrile SE, though this entity occurs primarily in early childhood. After a first episode, the risk of recurrence is similar to the risk after a first unprovoked seizure (25-40%). SE is expensive, regularly costing more than $10,000 per episode and often more than $100,000 for refractory cases.

CONCLUSION: Status epilepticus is not an uncommon neurologic emergency and depending on the associated etiology can carry significant morbidity, mortality, and cost especially if treatment is not performed in a timely manner.

Trend Of Increased Subsequent Epilepsy In Children With Recurrent Febrile Seizures: A Retrospective Matched Cohort Study.


PURPOSE: Trends of epilepsy in children were correlated with febrile seizure (FS) in a previous retrospective study. In the present study, the authors obtained relevant data from a nationwide cohort database to investigate trends in subsequent epilepsy in children with a history of recurrent FS.

METHODS: A total of 10,210 children with FS comprised the cohort. The diagnosis date was used as the index date. A comparison cohort was randomly matched with each case based on age, sex, urbanization level, parents’ occupation, and index date. Cox proportional hazard regression was performed to estimate the hazard ratio and confidence interval of FS-associated epilepsy.

RESULTS: This retrospective cohort study included 7729 children with FS and a comparison cohort of 30,916 children. The incidence of epilepsy was 11.4-fold higher in the FS cohort than in the comparison cohort (5.67 vs. 0.49 per 1000 person-years, respectively). Compared with the comparison cohort, the epilepsy incidence rate ratio increased in children with admissions for FS, from 8.62 at 1 admission to 26.2 at ?2 admissions (95% CI 6.80-10.9, and 19.78-34.8, respectively; p for trend < 0.0001).

CONCLUSION: Febrile seizures may increase the risk for subsequent epilepsy in children. Recurrent febrile seizures increased the cumulative incidence of epilepsy.

Seizure Characteristics Are Related To Tumor Pathology In Children With Brain Tumors.


OBJECTIVES: Brain tumors are found in 1-3% of children with newly onset of seizures. Understanding the impact of seizures on pediatric brain tumors and factors between seizures and brain tumors are crucial. This study aimed to evaluate the association of pediatric brain tumors on seizure occurrence and the relationships between seizures and the diagnosis and prognosis of brain tumors.

METHODS: In a cohort of 184 children with newly diagnosed brain tumors between August 2012 and September 2017, 56 patients with brain tumor-associated seizures were evaluated for their clinical characteristics, electroencephalography (EEG), tumor pathology, response to anti-epileptic drugs (AEDs) and their seizure outcome.

RESULTS: The prevalence of seizures in our cohort of children with brain tumors was 30.4% (n = 56/184). Supratentorial tumors were more commonly associated with seizures than were infratentorial tumors (89.3% vs. 10.7%; P < 0.01). Among patients with tumor-associated seizures, the tumors were most commonly located in the temporal lobe (32.1%), followed by the frontal (21.4%) and parietal lobes (16.1%) and other cortices. Thirty-four patients (60.7%) had benign tumor pathology and 22 patients (39.3%) had malignant tumor pathology; low grade astrocytoma (n = 15; 26.8%) was the most common histology type. Seizure onset at initial presentation was more frequently observed in the patients with benign tumors, whereas the patients with malignant tumors tended to have delayed seizure onset (P < 0.01). On EEGs, focal epileptiform discharges were more commonly seen in benign tumors, whereas focal and diffuse slow waves were most commonly associated with malignant tumors. Levetiracetam was the most commonly prescribed AED to treat brain-tumor-associated seizures.

CONCLUSIONS: In children with brain tumors, higher seizure frequency with normal neurologic examination was more prevalent in benign tumors, whereas less frequent seizures with focal weakness and signs of increased intracranial pressure were more indicative of malignancy. Delayed onset of seizures was more often observed in the children with malignant brain tumors. Seizure characteristics play an important role in relation to tumor biology and epileptogenesis in pediatric brain tumors.