The risk of recurrent status epilepticus in 95 children followed prospectively for a mean of 29 months was determined at the Montefiore Medical Center and affiliated hospitals of Albert Einstein College of Medicine, Bronx, New York. Ages ranged from 1 month to 18 years (mean 4 years). The cause was idiopathic in 24, remote symptomatic in 18, febrile in 29, acute asymptomatic in 18 or a progressive neurologic disorder in 6. Neurologically abnormal children (34% of the study population) accounted for 88% of the recurrent status group and for all 5 children with multiple episodes of status epilepticus. The risk was related to the severity of the neurological abnormality, the multiply handicapped children being at highest risk. Fifteen of 16 children with recurrent status epilepticus were being treated with anti-epileptic drugs at the time of recurrence. The morbidity and mortality of status epilepticus were low. [1]
COMMENT. The authors indicate that status epilepticus in neurologically normal children is by and large an isolated event that should not unduly influence decisions regarding further therapy. The high risk subgroup of neurologically abnormal children with recurrent status epilepticus underscored the need for better treatment strategies.
The more frequent use of neurosurgical treatment of refractory status epilepticus is suggested by Gorman DG et al. in a report from the UCLA Pediatric Epilepsy Research Program, Los Angeles, CA [2]. The resection of a right frontal focus in a 9 year old boy with left focal motor seizures and status epilepticus was followed by immediate control of the seizures and no seizures for more than 1 year post-operatively while using carbamazepine monotherapy.