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Outcomes in Children Treated with Pentobarbital Infusion for Refractory and Super-Refractory Status Epilepticus

  • Jennifer Erklauer
  • Jeanine Graf
  • Mona McPherson
  • Anne Anderson
  • Angus Wilfong
  • Charles G. Minard
  • Laura Loftis
Original Article

Abstract

Background

Functional neurologic outcome for children with refractory and super-refractory status epilepticus has not been well defined.

Methods

Retrospective chart review including children age 0–17 years who received pentobarbital infusion from 2003 to 2016 for status epilepticus. Outcomes were defined in terms of mortality, need for new medical technology assistance at hospital discharge and functional neurologic outcome determined by pediatric cerebral performance category score (PCPC). Potential patient characteristics associated with functional neurologic outcome including age, sex, ethnicity, etiology of the status epilepticus, and duration of pentobarbital infusion were evaluated.

Results

Forty children met inclusion criteria. In-hospital mortality was 30% (12/40). Of survivors, 21% (6/28) returned to baseline PCPC while half (14/28) declined in function ≥ 2 PCPC categories at hospital discharge. 25% (7/28) of survivors required tracheostomy and 27% (7/26) required new gastrostomy. Seizures persisted at discharge for most patients with new onset status epilepticus while the majority of patients with known epilepsy returned to baseline seizure frequency. Etiology (p = 0.015), PCPC at admission (p = 0.0006), new tracheostomy (p = 0.012), and new gastrostomy tube (p = 0.012) were associated with increase in PCPC score ≥ 2 categories in univariable analysis. Duration of pentobarbital infusion (p = 0.005) and length of hospital stay (p = 0.056) were longer in patients who demonstrated significant decline in neurologic function. None of these variables maintained statistical significance when multiple logistic regression model adjusting for PCPC score at admission was applied. At long-term follow-up, 36% (8/22) of children demonstrated improvement in PCPC compared to discharge and 23% (5/22) showed deterioration including three additional deaths.

Conclusions

Mortality in this population was high. The majority of children experienced some degree of disability at discharge. Despite prolonged pentobarbital infusion, there were cases of survival with good neurologic outcome.

Keywords

Refractory status epilepticus Super-refractory status epilepticus Pediatric intensive care unit Functional neurologic outcome Pediatric cerebral performance category Pentobarbital infusion 

Abbreviations

SE

Status epilepticus

RSE

Refractory status epilepticus

SRSE

Super-refractory status epilepticus

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PediatricsBaylor College of Medicine, Texas Children’s HospitalHoustonUSA
  2. 2.Department of PediatricsBaylor College of Medicine, Texas Children’s HospitalHoustonUSA
  3. 3.Division of Pediatric NeurologyBarrow Neurologic InstitutePhoenixUSA
  4. 4.Dan L. Duncan Institute for Clinical and Translational ResearchBaylor College of MedicineHoustonUSA

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