Demographic and aetiological factors of paediatric status epilepticus: a South African retrospective observational study

Abstract

Background. Status epilepticus (SE) is a common medical neurological emergency in childhood, often serious and life threatening. A paucity of data exists on the aetiology and demographics of affected children in resource-limited countries. 

Objective. To understand the demographics and describe the common causes of convulsive status epilepticus (CSE) in our local paediatric population.  

Methods. A retrospective review of the demographics, clinical features, and characterisation of CSE of children who presented to the emergency department of Red Cross War Memorial Children’s Hospital, in Cape Town, South Africa, between 2016 and 2018 was completed.  

Results. Of 119 children, 63 (53%) were male; their median age was 29.6 (IQR 14.8-76.1) months: 22 (18%) were <12-months, 63 (53%) were 1-5 years, and 34 (29%) >5years. Thirty-one (26%) were moderately-severely-underweight-for-age and 5 (4%) were HIV-infected. In seizure semiology, 82 (71%) had generalised convulsive seizures and 34 (29%) had focal seizures; with ILAE-classified aetiology 74 (62%) were secondary to acute infective cause, 12 (10%) electroclinical syndrome, 9 (8%) remote and 25 (22%) were unknown. A recorded tympanic membrane temperature of ≥38°C was found in 49 (44%) of 112 children, 36 were below the age of 5 years, supporting the diagnosis of febrile status epilepticus in these children. Fifty (42%) were known with epilepsy related breakthrough seizures. Imaging was abnormal in 24 (42%) of 57 children. Cerebrospinal fluid findings were abnormal in 7 (12%) of 57 children. Most children, 87 (75%), were stabilised adequately for admission in the short stay ward, however eight required admission to the ICU. No deaths were recorded in the cohort. 

Conclusion. Acute infections are the most common cause of SE in our setting, concordant with other studies.