title: Short-term outcomes and major barriers in the management of convulsive status epilepticus in children: a study in Georgia.
abstract: OBJECTIVE
  Convulsive status epilepticus is the most common childhood neurological emergency in developing countries, where poor healthcare organisation could play a negative role in the management of the condition. Unavailability of second-line injectable anticonvulsants is an additional hindering factor in Georgia. This report reflects the results of the first study aimed at evaluating the epidemiological features of convulsive status epilepticus, as well as identifying obstacles influencing the management of patients with convulsive status epilepticus in Georgia.
  
  
  METHODS
  A prospective, hospital-based study was performed. Paediatric patients with convulsive status epilepticus, admitted to the emergency department of a referral academic hospital from 2007 to 2012, were included in the study.
  
  
  RESULTS
  Forty-eight paediatric patients admitted to hospital met the criteria for convulsive status epilepticus. Seizure duration was significantly shorter among the group with adequate and timely pre-hospital intervention. Moreover, patients with appropriate pre-hospital treatment less frequently required mechanical ventilation (p=0.039). Four deaths were detected during the follow-up period, thus the case fatality rate was 8%. Only 31% of patients received treatment with intravenous phenytoin.
  
  
  CONCLUSIONS
  The study results show that adequate and timely intervention could improve outcome of convulsive status epilepticus and decrease the need for mechanical ventilation. Mortality parameters were comparable to the results from other resource-limited countries. More than one third of patients did not receive appropriate treatment due to unavailability of phenytoin.
authors.affiliation: M.Iashvili Children Central Hospital - Neuroscience.
authors.forename: Teona
authors.initials: T
authors.lastname: Shatirishvili
authors.affiliation: M.Iashvili Children Central Hospital - Neuroscience.
authors.forename: Tamar
authors.initials: T
authors.lastname: Kipiani
authors.affiliation: Institute of Neurology and Neuropsychology - Epilepsy.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Lomidze
authors.affiliation: Neurodevelopment Center - Mental health, Tbilisi, Georgia.
authors.forename: Maia
authors.initials: M
authors.lastname: Gabunia
authors.affiliation: M.Iashvili Children Central Hospital - Neuroscience.
authors.forename: Nino
authors.initials: N
authors.lastname: Tatishvili
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D013226:Status Epilepticus / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000628:therapy
keywords: AED unavailability; convulsive status epilepticus; morbidity; outcome