The differences between paediatric and adult convulsive SE

Childhood convulsive status epilepticus is more common, has different causes, and has a lower risk of death than the adult disorder, according to a recent study.Authors reporting the results of the North London Status Epilepticus in Childhood Surveillance Study (NLSTEPSS) explain that they undertook the study to obtain a uniquely paediatric perspective of status epilepticus. They say that previously-reported epidemiological studies have been mainly based on adult populations, which may not be reflective of the disorder in children.To determine the incidence, cause and outcome of convulsive status epilepticus in the paediatric population, the investigators obtained clinical and demographic data for episodes that took place in North London over a 2-year period. Of 226 children enrolled in the study, 176 had a first-ever episode of convulsive status epilepticus. From these figures, the authors estimated an adjusted incidence of between 17 and 23 episodes per 100 000 children per year, which is much higher than the estimated incidence of 4-6 episodes per 100 000 per year in published epidemiological studies in adult populations.Over half the children (56%) with a first-ever episode were previously neurologically healthy (healthy neurodevelopment, no history of epilepsy, and no neurological deficits). A third of episodes were prolonged febrile seizures, and acute symptomatic convulsive status epilepticus occurred in 17% of cases. The authors report that most children with acute symptomatic convulsive status epilepticus had either acute metabolic derangement or an acute CNS infection. In 7% of children, the cause of the episode could not be identified. Case fatality was 3%.Analysing the results, the authors conclude that there is a higher likelihood of acute bacterial meningitis in children with first ever convulsive status epilepticus associated with fever, whereas this is rare in adults. They add, "Other notable differences are that low antiepileptic drug concentrations and cerebrovascular disease are common causes of acute symptomatic convulsive status epilepticus in adults, whereas, only two children in our study had acute symptomatic convulsive status epilepticus attributable to these causes."Reference...