Initial clinical features of neurologic sequelae in children with refractory status epilepticus and fever after intensive care management

Abstract

  Objective: Although targeted temperature management (TTM) has been reported to improve the outcomes of children with refractory status epilepticus and fever, some TTM-treated children exhibit poor outcomes. We aimed to explore the initial clinical characteristics of children with prognostic symptoms who underwent TTM for refractory status epilepticus and fever. Methods: We retrospectively reviewed the clinical records of 5 children with refractory status epilepticus and fever who underwent TTM at the Kakogawa East City Hospital and Hyogo Children’s Hospital from 2010-2015. We compared the initial clinical characteristics of the children with and without prognostic symptoms. Results: Two patients with prognostic symptoms showed impaired consciousness with dilated pupils after convulsion cessation, and they were suspected to have non-convulsive status epilepticus (NCSE). The time between the first-line treatment of diazepam infusion and the second-line treatment of midazolam administration was longer in children with prognostic symptoms than in those without. Conclusions: Children with refractory status epilepticus, fever, and dilated pupils after convulsion cessation had prognostic symptoms and longer delays before second-line treatment. Typically, the outcomes of refractory status epilepticus and fever depend on the underlying disease, but it was believed here that protraction of NCSE and a delay in the additional treatment might have been related to the poor outcomes.