title: Severe refractory status epilepticus owing to presumed encephalitis.
abstract: The severe refractory type of status epilepticus is very rare in the pediatric population. Eight children with the severe refractory type of status epilepticus owing to presumed encephalitis are described. The age at the onset of status epilepticus of the eight study children ranged between 2.5 and 15 years. Seven of the eight children presented with fever several days prior to the onset of seizures. A comprehensive clinical and laboratory investigation failed to delineate a cause for their seizures. Burst suppression coma was induced by pentothal, midazolam, propofol, or ketamine in all of the children. The mean duration of anesthesia was 28 days (range 4-62 days), but the seizures persisted in spite of repeated burst suppression cycles in all of them. Two children died. Four of the surviving children continued to suffer from seizures, and cognitive sequelae were present throughout follow-up in four children. In summary, the severe refractory type of status epilepticus of the acute symptomatic type owing to relatively mild encephalitis carries a high mortality rate and poor morbidity in terms of seizures and cognition at follow-up.
authors.affiliation: Child Development Center and Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Israel. umkramer@netvision.net.il
authors.forename: Uri
authors.initials: U
authors.lastname: Kramer
authors.forename: Zamir
authors.initials: Z
authors.lastname: Shorer
authors.forename: Bruria
authors.initials: B
authors.lastname: Ben-Zeev
authors.forename: Tally
authors.initials: T
authors.lastname: Lerman-Sagie
authors.forename: Hadassa
authors.initials: H
authors.lastname: Goldberg-Stern
authors.forename: Eli
authors.initials: E
authors.lastname: Lahat
mesh_terms: D000293:Adolescent; D000777:Anesthetics / Q000008:administration & dosage; D000927:Anticonvulsants / Q000008:administration & dosage; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004569:Electroencephalography; D004660:Encephalitis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D000927:Anticonvulsants; D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous