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Neurological, cognitive and neuroimaging outcomes within 10 years of childhood status epilepticus: a cohort study
  1. SS Pujar1,2,3,
  2. MM Martinos4,
  3. WK Chong5,6,
  4. BGR Neville1,2,3,
  5. RC Scott1,2,7,
  6. RFM Chin1,8,9
  1. 1Neurosciences Unit, University College London Institute of Child Health, London, UK
  2. 2Neurosciences Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK
  3. 3Epilepsy Unit, Young Epilepsy, Lingfield, UK
  4. 4Developmental Cognitive Neurosciences Unit, University College London Institute of Child Health, London, UK
  5. 5Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
  6. 6Radiology and Physics Unit, University College London Institute of Child Health, London, UK
  7. 7Department of Neurology, Dartmouth Medical School, Hanover, USA
  8. 8MRC Centre of Epidemiology for Child Health, University College London Institute of Child Health, London, UK
  9. 9Muir Maxwell Epilepsy Research Centre, Child Life and Health, University of Edinburgh, Edinburgh, UK

Abstract

Aims Long-term outcomes following childhood convulsive status epilepticus (CSE) are uncertain. Determining morbidities following CSE and their predictors will be useful for prognostication and planning resource allocation.

We are now following up our original prospectively ascertained population-based cohort of children with CSE to determine their outcomes within 10 years. Here we present data on neurological, cognitive and neuroimaging outcomes.

Methods Enrolled children were invited for clinical neurological evaluation, cognitive assessment using Wechsler Abbreviated Scale of Intelligence (WASI), and brain MR Imaging (MRI) on a 1.5T scanner. An experienced paediatric neuroradiologist qualitatively assessed all MRIs.

Results 63 children (28 male) have been enrolled. Median follow-up was 7.7 years. 41 children had complete (clinical, MRI and cognitive) assessment. 17 had prolonged febrile seizures (PFS), 7 acute symptomatic (AS), 8 remote symptomatic (RS), 6 idiopathic, and 3 unclassified CSE.

All children with PFS were neurologically normal, had full-scale IQ scores >80, and none had epilepsy. Only one child (6%) had abnormal MRI: unilateral reduction in hippocampal volume without signal change. Amongst children with AS CSE, none had active epilepsy; MRI was normal in 3 (43%), abnormal unlikely to be clinically significant in 3 (43%), and 1 (14%) had left mesial temporal sclerosis (MTS). The child with MTS had only one episode of CSE with pneumococcal meningitis and no further seizures. All had IQ scores >80.

All children with RS CSE, except one, had active epilepsy, significant cognitive (IQ score <70) and/or motor impairments. The MRI showed hypoxic ischemic injury in 2, compensated hydrocephalus in 2, and hypoglycaemic injury, perinatal middle cerebral artery infarction, unilateral reduction in hippocampal volume, and no abnormality in one each.

Two (33%) children with idiopathic CSE had active epilepsy and IQ score <70. The remaining had IQ score >90 and MRI was normal in all. All children with unclassified CSE had normal MRI, IQ score >80, and no epilepsy.

Conclusion Preliminary results suggest children without prior neurological insult and/or epilepsy have good neurological and cognitive outcomes within 10 years of CSE. The significance of the hippocampal abnormalities in three children without a clinical correlate is uncertain.

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