Central nervous system infections and status epilepticus association, clinical profile and outcomes in children hospitalized with new-onset acute symptomatic seizures

[Clinical features and prognosis of influenza-associated encephalopathy in children].

Clinical profile and short-term outcome of convulsive status epilepticus in children aged 1 month–12 years: A prospective observational study

Background: Convulsive status epilepticus (CSE) is a pediatric neurological emergency requiring urgent intervention. It may result from febrile illness, central nervous system infection, metabolic disturbances, or neurological disorders and may cause morbidity, mortality, and sequelae when treatment is delayed. Aims and Objectives: The aim of the study was to describe the clinical profile and etiological spectrum of CSE in children aged 1 month–12 years and identify factors associated with short-term outcome at discharge. Materials and Methods: This prospective observational study included 100 consecutive children aged 1 month–12 years admitted with CSE to the pediatric intensive care unit or child medical ward of a tertiary care hospital. Clinical details, examination findings, investigations, neuroimaging, cerebrospinal fluid examination, and electroencephalography were recorded when indicated. Outcomes at discharge were classified as complete recovery, neurological deficit, or death. Results: Children aged 1–5 years formed the largest subgroup, with a slight male predominance. Fever was the most common clinical feature, and generalized tonic-clonic seizures were the predominant seizure type. Acute symptomatic etiology was most frequent, followed by febrile status and remote symptomatic causes. At discharge, 78% recovered completely, 16% had a neurological deficit, and 6% died. Unfavorable outcome was significantly associated with delayed treatment, seizure type, recurrent seizures after admission, acute symptomatic etiology, lower Glasgow Coma Scale score, and requirement of more antiepileptic drugs. Conclusion: Most children recovered fully; however, morbidity and mortality remained important. Early treatment and close monitoring of children with acute symptomatic etiology, depressed sensorium, recurrent seizures, or drug-refractory status are essential to improve short-term outcome.

Management Challenges and Clinical Characteristics of Refractory Status Epilepticus in Mexico: A 102 Patient Retrospective Cohort Study.

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.

Pediatric refractory status epilepticus: Predictors of in-hospital outcomes from a Chinese tertiary center.

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.

Clinical, epidemiological and laboratory characteristics of children with febrile seizures

Background: Febrile seizures are the most common seizure disorder in early childhood and represent a frequent cause of pediatric emergency visits. Understanding their clinical, epidemiological, and laboratory characteristics is essential for appropriate evaluation and management. Methods: A hospital-based observational study was conducted from March 2024 to February 2026 at Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru, after institutional ethics committee approval. Sixty-five children aged 6-60 months presenting with febrile seizures were enrolled. Children with afebrile seizures, central nervous system infections, congenital CNS malformations, or chronic illnesses were excluded. Demographic details, clinical characteristics, and laboratory parameters, including complete blood count, serum electrolytes, blood glucose, C-reactive protein, and urine examination, were recorded. Data were analyzed using descriptive statistics, Chi-square test, fisher's exact test, and independent t-test or Mann-Whitney U test as appropriate. Effect sizes were reported as Cramer's V for categorical associations, with 95% confidence intervals (CI). A p value of <0.05 was considered statistically significant. Statistical analysis was performed using IBM statistical package for the social sciences (SPSS) statistics version 26.0 (IBM Corp., Armonk, NY, USA). Normality of continuous variables was assessed using the Shapiro-Wilk test. Results: The mean age was 25.02±14.75 months, with most children aged 24-35 months (22/65, 33.8%). Males constituted 41/65 (63.1%) of cases. Most children presented with fever of 100-101 F (30/65, 46.2%), and 56/65 (86.1%) developed seizures within two days of fever onset. A single convulsion occurred in 46/65 (70.8%) of children. Hematological evaluation showed mild anaemia (mean hemoglobin 10.64±1.58 g/dl), leukocytosis (mean total leukocyte count 12,684.86±5,463.75 cells/mm3), and neutrophil predominance. Biochemical parameters were largely within normal limits except for mild hyponatremia (mean serum sodium 134.89±2.70 mEq/l). Urine abnormalities were detected in 11/65 (16.9%) of cases. Lower hemoglobin levels were significantly associated with multiple convulsions (Fisher's exact test, p=0.015, Cramer's V=0.368, 95% CI: 0.102-0.583). Conclusions: In this study, febrile seizures predominantly occurred in neurologically normal children below three years of age and were usually associated with short-duration fever and single seizure episodes. Mild anaemia was common and was significantly associated with seizure recurrence, suggesting its potential role as a clinically relevant laboratory marker in children with febrile seizures.

Diagnostic utility of cerebrospinal fluid analysis in children presenting with acute neurological emergencies at a tertiary care hospital

Background: Acute neurological emergencies include a wide range of conditions with variable and overlapping clinical presentations, making clinical diagnosis challenging. Advances in cerebrospinal fluid (CSF) analysis, serum antibody testing and neuroimaging have improved diagnostic accuracy. This study aimed to analyse the differentiating clinical, laboratory and neuroimaging features in children with various neurological emergencies. Methods: It was prospective observational study in children aged 1 month to 18 years between July 2022 and June 2024 presenting with acute neurological emergencies necessitating CSF analysis. Data were collected and analysed using IBM SPSS version 29. Results: Of the total (135), 37% were infants. CNS infections were most common (67; 49.6%), followed by demyelinating disorders (33; 24.4%), autoimmune encephalitis (7; 5.2%), metabolic encephalopathy (2; 1.5%) and other diagnoses (26; 19.3%). Bacterial meningitis (28.4%) and acute demyelinating encephalomyelitis (45.5%) were the most common conditions in their respective groups. Fever and lethargy predominated in CNS infections and demyelinating disorders. Key features in ADEM were difficulty in walking (45.5%) and acute onset weakness (45.5%). Altered sensorium (71.4%) and altered behaviour (42.9%) were predominant in autoimmune encephalitis. 93.3% ADEM and 87.5% optic neuritis were MOG (Myelin Oligodendrocyte Glycoprotein) antibody positive with MRI abnormalities (90.9%). 47% autoimmune encephalitis positive for anti-NMDAR (N-methyl-D-aspartate receptor) antibody with EEG (electroencephalogram) abnormalities (57.1%). Conclusions: Serum antibody testing aids in diagnosing demyelinating and autoimmune disorders, while CSF polymerase chain reaction (PCR) helps identifying pathogens in culture-negative CNS infections. CSF analysis has limited utility in noninfective conditions.