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Demographic and aetiological factors of paediatric status epilepticus: a South African retrospective observational study

Originally published In South African Journal of Child Health: 26 February 2024

Convulsive status epilepticus (CSE) is a severe neurological emergency in children, lasting more than 5 minutes or with recurrent seizures without regaining consciousness. Global prevalence varies, with higher rates in early childhood, and a higher incidence in sub-Saharan Africa, often due to infectious diseases. Febrile seizures are common, particularly in children under 5. 

Early and aggressive intervention, tailored to local resources, is crucial. Despite challenges in resource-limited settings, prompt identification of underlying causes can improve outcomes. Limited data exists on the demographics and causes of CSE in sub-Saharan Africa, warranting further investigation to guide effective management strategies.

The study investigated convulsive status epilepticus (CSE) in children at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa.

• Of the 119 children, 53% were male, with a median age of 29.6 months. 26% were underweight, and 4.2% were HIV-infected, all on antiretroviral treatment. 
• 42% had known epilepsy, and 88% were on antiseizure medication (ASM), with 23% non-compliant.
• Febrile SE was prevalent, particularly in children under 5 years.
• Imaging abnormalities were found in 42% of cases, and 12% had abnormal cerebrospinal fluid findings. 
• Most children (75%) were stable for short-stay ward admission, while 8 required ICU admission. No deaths were recorded. 
• The most common seizure type was generalized CSE (71%) due to acute infections (62%).
• The final diagnosis for CSE with acute infectious aetiology included upper respiratory tract infections (40%) and CNS infections (7%).

Future research should explore aetiological variances in pediatric ICU admissions due to CSE and investigate its impact on neurodevelopmental outcomes. Improved pathways to care and awareness for early interventions are essential. Understanding non-compliance and ASM levels, ensuring adequate drug supply, and educating clinicians on drug monitoring are crucial

Access the original article
 

S Chingwali-Nsanta,1 BSc, MB ChB, FC Paed (RSA); H Buys,1,3 FCPaed (SA), MRCP (UK), MSc (Paed);R J Burman,4 BMedSci (Hons), MSc (Med), MB ChB (UCT);J M Wilmshurst,1,2 MB BS, MRCP (UK), FCPaed (SA), MD
Demographic and aetiological factors of paediatric status epilepticus: a South African retrospective observational study. (2024). South African Journal of Child Health, 18(1), e2019. https://doi.org/10.7196/

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