title: Clinical profile and outcome of refractory convulsive status epilepticus in older children from a developing country.
abstract: OBJECTIVE
  The current study evaluates the etiology, clinical course and outcome of refractory convulsive status epilepticus (CSE) in older children.
  
  
  METHODS
  Retrospective analysis of data of 73 children with CSE, aged ≥2 and ≤12 years was performed. Odds ratios were calculated between variables for clinical course and outcome. Mortality of the group was analyzed using survival analysis.
  
  
  RESULTS
  Thirty three (45.2%) children progressed to refractory status epilepticus (RSE). The most common etiology for CSE was acute symptomatic in 44 (60.3%) of which 37 had presumed CNS infections. The odds of progressing to RSE were higher in children with acute symptomatic etiology (OR 2.62; CI - 95%; 0.99-7.14; p=0.041). Progression to RSE increased the chances of severe sepsis by six times (OR 6.08; CI - 95%; 1.19-31.02; p=0.036) and acidosis by nearly 15 times (OR 14.77; CI - 95%; 1.19-31.02; p=0.020). Overall mortality was 13.7%, higher in RSE (21.2% vs.7.5%). Amongst the 63 surviving children followed for 1 year from discharge, progression to RSE increased the odds of disability by seven times (OR 7.08; CI 29.31; p=0.004).
  
  
  CONCLUSIONS
  Acute symptomatic etiology was the commonest cause of CSE among older children from developing country and increased the odds of progressing to RSE. RSE was significantly associated with disability at 1 year from discharge.
authors.affiliation: Department of Neurology, Rainbow Hospital for Women and Children, Hyderabad, India. Electronic address: siriloki@gmail.com.
authors.forename: Lokesh
authors.initials: L
authors.lastname: Lingappa
authors.affiliation: Department of Neurology, Rainbow Hospital for Women and Children, Hyderabad, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Konanki
authors.affiliation: Department of Neurology, Rainbow Hospital for Women and Children, Hyderabad, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Vooturi
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India.
authors.forename: Sita
authors.initials: S
authors.lastname: Jayalakshmi
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; C025429:methyl prednisolonate; D011239:Prednisolone
keywords: Acute symptomatic; Convulsive status epilepticus; Disability; Mortality; Refractory