The most common thresholds for considering prolonged seizures as status epilepticus (SE) are 5 and 30min. It is unknown whether these different thresholds (5 or 30min) identify patient populations with different electroclinical characteristics. We compared the characteristics of patients with SE lasting 5-29min (SE5-29) with those with SE lasting ≥30min (SE≥30). Inclusion criteria were the following: 1) 1month to 21years of age at the time of SE, 2) convulsive seizures, and 3) seizure duration ≥5min. Exclusion criteria were the following: 1) exclusively neonatal seizures, 2) psychogenic nonepileptic seizures, or 3) incomplete information about seizure duration. Four hundred forty-five patients (50.1% male) with a median (p25-p75) age at SE of 5.5 (2.8-10.5) years were enrolled. Status epilepticus lasted for 5-29min in 296 (66.5%) of subjects and for ≥30min in 149 (33.5%). Patients with SE≥30 were younger than the patients with SE5-29 at the time of seizure onset (median: 1 versus 2.1years, p=0.0007). Status epilepticus as the first seizure presentation was more frequent in patients with SE≥30 (24.2% versus 12.2%, p=0.002). There was a tendency towards a higher rate of abnormalities in the magnetic resonance imaging at baseline in patients with SE≥30 (70.5% versus 57.1%, p=0.061). Differences were not detected in seizure frequency, seizure types, presence of developmental delay, and electroencephalogram abnormalities at baseline. In the pediatric population, SE thresholds of either 5 or 30min identify groups of patients with very similar electroclinical characteristics, which may influence future definitions of pediatric SE.
Bibliographical noteFunding Information:
Tobias Loddenkemper serves on the Laboratory Accreditation Board for Long-term (Epilepsy and ICU) Monitoring (ABRET), serves as a member of the American Clinical Neurophysiology Council (ACNS), serves on the American Board of Clinical Neurophysiology, serves as an Associate Editor of Seizure, performs video EEG long-term monitoring, EEGs, and other electrophysiological studies at Boston Children's Hospital and bills for these procedures, receives support from the HHV6 foundation NIH/ NINDS and PCORI by the Payer Provider Quality Initiative, receives funding from the American Epilepsy Society , the Epilepsy Foundation of America, the Epilepsy Therapy Project , the Pediatric Epilepsy Research Foundation , CURE , and the Danny Did Foundation , and received investigator initiated research support from Eisai Inc. and Lundbeck LLC .
Iván Sánchez Fernández is funded by a grant for the study of epileptic encephalopathies from “ Fundacion Alfonso Martín Escudero ” and the HHV6 Foundation .
This study was supported by a Career Development Fellowship Award from Harvard Medical School and Boston Children's Hospital (TL) and by a grant from the Program for Quality and Safety at Boston Children's Hospital (TL).
- Status epilepticus