Aug 2026· Neurocritical Care· 0 citations· 31 references
Medicine
TL;DR
Real-world insights into RSE in a resource-limited setting are offered, highlighting preventable causes, management complexity, and high care demands, and favorable outcomes are often achievable.
Refractory status epilepticus (RSE) is a life-threatening neurological emergency in children. However, real-world evidence on pediatric RSE remains limited. This study characterized treatment patterns, in-hospital outcomes, and predictors of clinical outcomes within a resource-constrained regional referral network. We performed a single-center retrospective cohort study of pediatric patients admitted with RSE between March 2018 and March 2026. Demographic, clinical, treatment, and outcome data were systematically collected. A total of 215 pediatric RSE episodes were included (median age, 8.0 years; interquartile range [IQR], 5.8-11.8 years); 45.1% were female, and 39.5% had a history of epilepsy. All patients received benzodiazepines as first-line therapy, but only 67 episodes received guideline-recommended dosing. Diazepam, levetiracetam, and midazolam infusion were the most commonly used first-, second-, and third-line therapies, respectively. Favorable discharge outcomes were observed in 50.7% of patients and were independently associated with prior epilepsy (odds ratio [OR], 2.379; 95% confidence interval [CI], 1.07-5.27), adequate first-line benzodiazepine dosing (OR, 2.104; 95% CI, 1.02-4.33), and shorter duration of status epilepticus (OR, 1.991; 95% CI, 1.53-2.58). In-hospital mortality was 15.3% and was associated with acute etiologies (OR, 3.265; 95% CI, 1.27-8.40); prior epilepsy was inversely associated with mortality (OR, 0.328; 95% CI: 0.15-0.73). In-hospital mortality in pediatric RSE is associated with acute etiologies, whereas prior epilepsy is associated with lower mortality. Favorable functional outcomes are associated with prompt guideline-concordant first-line treatment and shorter seizure duration. These findings suggest that key prognostic determinants of pediatric RSE are consistent across different resource settings.
Beyond the clinical severity of NORSE, the findings show that cohort composition is highly sensitive to the temporal operationalization of consensus criteria, and standardized application of diagnostic timing may therefore be essential for comparability across NORSE studies.
C. Jünemann, Meike Menche, Marc-Philipp Bergmann et al.· Neurological Research and Pr...· 0 citations
PURPOSE
To evaluate clinical determinants of refractoriness and outcome in status epilepticus (SE) in a prospective low- and middle-income country (LMIC) cohort.
METHODS
In this single-centre prospective cohort study, 97 consecutive SE patients were classified as non-refractory status (NRSE, n = 50), refractory (RSE, n = 31), or super-refractory SE (SRSE, n = 16). A single 21 channel video-EEG was done within 24 h of presentation to the hospital. Clinical context, preexisting epilepsy history, etiology, Status Epilepticus Severity Score (STESS) and EEG findings were recorded, and outcome was assessed through in-hospital mortality.
RESULTS
The median age of our cohort was 32 years; most common etiologies were remote symptomatic (68%), acute symptomatic (19%) and progressive symptomatic (5%). Patients with drug-sensitive epilepsy (DSE) showed low refractoriness and mortality (29%, 6%), whereas drug-resistant epilepsy and new-onset status epilepticus (NOSE) were more likely to be refractory (68% and 70% respectively) and had higher mortality (26% and 30% respectively). Overall mortality was 16.5%, increasing stepwise from 4% (NRSE) to 13% (RSE) to 63% (SRSE; p < 0.001). STESS discriminated between non-survivors and survivors (median 3 vs 0; p < 0.001). Among 85 patients with available EEG, periodic discharges (PDs) were associated with 71% mortality (p < 0.001).
CONCLUSION
Status Epilepticus in the setting of DSE carries a favourable prognosis, while DRE and NOSE confer refractoriness. A short-term early EEG performed in the first 24 h is associated with refractoriness and its exact role warrants further studies.
S. Lodha, Babu Rao Challepalle, Shubho Acharya et al.· Epilepsy & Behavior· 0 citations
Findings highlight the substantial burden of severe neurological complications in children presenting with first-time seizures and underscore the critical role of timely recognition of CSE and CNS infections in resource-limited settings.
Kiều Thị Thúy Huỳnh, V. K. Le, T. Nguyen· Medicine· 0 citations
BACKGROUND
Convulsive status epilepticus (CSE) is a time-sensitive neurological emergency in which delayed treatment may contribute to pharmacoresistance and poor outcomes. Evidence comparing third-line antiseizure medications in children remains limited. Objective To compare intravenous lacosamide and phenytoin in pediatric refractory CSE and to determine whether treatment timing predicts seizure cessation. Methods This prospective observational cohort study included 100 children aged 1 month-16 years with refractory CSE treated with intravenous lacosamide (n = 46) or phenytoin (n = 54) after failure of benzodiazepines and levetiracetam. The primary objective was to evaluate the effect of treatment delay on seizure cessation. Secondary outcomes included treatment response, electroencephalographic findings, cardiac safety, and predictors of treatment failure. Results Seizure cessation was achieved in 56% of patients and did not differ significantly between lacosamide and phenytoin (60.9% vs. 51.9%, p = 0.365). Treatment delay was the strongest independent predictor of failure; each additional hour from seizure onset to treatment initiation increased the odds of failure by 11% (adjusted OR 1.11, 95% CI 1.03-1.19; p = 0.005). Greater baseline antiseizure medication burden was also independently associated with treatment failure (adjusted OR 2.10, 95% CI 1.05-4.17; p = 0.035). Persistent epileptiform activity on 24-hour EEG was significantly associated with poor outcome (p < 0.001). Both medications were well tolerated. Conclusions Lacosamide and phenytoin demonstrated comparable efficacy and safety. Treatment timing, rather than drug selection, was the principal determinant of seizure cessation, emphasizing the importance of rapid escalation of therapy in pediatric refractory CSE.
Michael Nabil Halim, Rasha Hussein Aly Hussein, O. El-Rashidy et al.· Epilepsy & Behavior· 0 citations
PURPOSE
The prognostic significance of nonconvulsive status epilepticus (NCSE) compared with convulsive status epilepticus (CSE) remains uncertain. We compared clinical features, treatment burden and outcomes of both phenotypes in critically ill adults, and assessed independent predictors of mortality and functional outcome.
METHODS
We conducted a retrospective study of 168 adults with status epilepticus admitted to a tertiary intensive care unit. After exclusion of 4 patients with undocumented semiology, the comparative cohort included 164 patients: 83 with CSE and 81 with NCSE. Five patients evolving from CSE to NCSE were classified as NCSE. NCSE was diagnosed using clinical assessment, EEG monitoring and the Salzburg Consensus Criteria. Outcomes were hospital mortality and modified Rankin Scale (mRS) >3 at discharge. Multivariable logistic regression identified independent predictors.
RESULTS
Baseline age, APACHE II score and Glasgow Coma Scale did not differ between groups. Among NCSE patients, 35 fulfilled Salzburg criterion IIA and 36 criterion IIB. A benzodiazepine diagnostic trial was recorded in 27 patients, with EEG improvement in 25. Hospital mortality was similar in CSE and NCSE (34%vs 32%; p = 0.869). NCSE was associated with greater treatment burden, longer time to seizure control, longer ICU stay and worse functional outcome (mRS >3: 57% vs 84%; p < 0.001). Mortality was independently associated with age, anoxic encephalopathy and super-refractory status, but not NCSE. NCSE independently predicted poor functional outcome.
CONCLUSION
NCSE did not independently increase mortality, but was associated with greater therapeutic complexity and worse functional outcome at discharge, supporting early EEG monitoring and etiology-guided treatment.
A. Canabal-Berlanga, Isabel Magaña, C. Alvargonzález et al.· Seizure· 0 citations
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