Introduction RCSE is a life-threatening neurologic emergency with high mortality and morbidity, in which seizures do not respond to first and second – line anticonvulsant drug therapy.

The aim of this study was to determine the risk factors, and the impact on the outcome of RCSE in children.

Patients and methods In this prospective study we analyse 53 children with RCSE.

Factors associated with seizure refractoriness were analysed using logistic regression.

Results Of 245 patients with convulsive status epilepticus, 53 developed RCSE (21.6%), 37 of whom were males (70%), with a mean age of 3 years (1 month–15 years). 11 patients (21%) had a history of epilepsy.

The most frequent etiologies’ were acute symptomatic (73, 6%). Encephalitis 13 patients (24, 5%), meningitis 8 patients (15%), septic shock 5 patients (9, 4%), were the main acute etiologies.

Acute symptomatic causes (odds ratio [OR] 9, 95% confidence interval [CI] 3.86–24.168; p < 1^–4), duration of CSE ≥ 6 h (OR 5,8% [CI] 1.828–18.778; pp = 00034), complications (OR 13 [CI] 4.324–40.108; pp < 1^–4) and received > 2 doses of benzodiazepines (OR 5 [CI] 1.133–25.425; pp = 0034) were identified as independent risk factors for RCSE.

During hospitalisation 24 patients (45%) died (p < 1^–4). On discharge from hospital, 14 patients (26.4%) presented new neurological deficit or difficult-to-manage epilepsy.

RCSE was associated with prolonged hospital length of stay (> 3 days) (p < 1–4).

Conclusion GCSE termination and outcome seem clearly associated with adherence to treatment protocol, etiologies and duration of the CSE.