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Submitted
February 21, 2021
Accepted
June 17, 2021
Published
July 1, 2021
Main Article Content
Abstract
Background: Optimal care of Convulsive status epilepticus (CSE) can be related to multiple barriers in resource-limited countries.
Objectives and methods: Since limited data of CSE management are available from South-East Africa, we performed a retrospective analysis of the electronic records of pediatric patients with CSE admitted to the Maputo Central hospital from January 2016 until April 2019.
Results: Our database consisted out of 39 patients. The average age was 5.15 (range 0.3-13.8) years and demographic characteristics did not show a relation to CSE characteristics or outcomes. However, the total stay in the hospital was negatively correlated with age (p=0.0314). Moreover, 14 patients needed to be admitted to the IC, which was correlated to having generalized motor seizures (p=0.0253), and a relatively higher need for a second AED to control their CSE (p=0.0131). Regarding AED use, the first AED was a IV benzodiazepine (BZD: midazolam (MIDA) or diazepam (DIAZ)) or IV phenytoin (PHEN) when BZDs were not available. There was no statistically significant difference between the efficacy of MIDA vs. DIAZ. Eleven patients received PHEN as a second-line drug, of which only two patients needed an additional dose of PHEN. None of the patients died and five patients (13.2%) had an extra comorbidity after CSE.
Conclusions: Although limited AEDs were available in our study, compared to more AEDs in other developing and developed countries, we report the successful cessation of CSE in the majority of cases. We recommend strategies to improve prehospital management such as the use of non-IV BZD use, to limit the need for patients to be admitted to the IC and thereby potentially decreasing the number of AEDs, morbidity and hospital duration. Moreover, our data underline the conversion to second-line AEDs (PHEN) to be adequate in nearly all patients.
Keywords
mozambique
status epilepticus
epilepsy
treatment gap
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Copyright (c) 2021 Jo Marie. B. Sourbron, Lieven Lagae, Dalila Ibrahimo Sulemane
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How to Cite
Sourbron, J. M. B., Lagae, L., & Sulemane, D. I. (2021). Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?. Journal of the International Child Neurology Association, 1(1). https://doi.org/10.17724/jicna.2020.194
References
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1. Moshe SL, Perucca E, Ryvlin P, Tomson TT, Moshé SL, Perucca E, et al. Epilepsy: new advances. Lancet (London, England) [Internet]. 2015 Mar 5;385(9971):884–98. Available from: http://dx.doi.org/10.1016/S0140-6736(14)60456-6
2. Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol. 2015 Jun;14(6):615–24.
3. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA. 1993 Aug;270(7):854–9.
4. Scott RC, Surtees RA, Neville BG. Status epilepticus: pathophysiology, epidemiology, and outcomes. Arch Dis Child. 1998 Jul;79(1):73–7.
5. Jafarpour S, Stredny CM, Piantino J, Chapman KE. Baseline and outcome assessment in pediatric status epilepticus. Seizure. 2019 May;68:52–61.
6. Sanchez Fernandez I, Goodkin HP, Scott RC. Pathophysiology of convulsive status epilepticus. Seizure. 2019 May;68:16–21.
7. Arif H, Hirsch LJ. Treatment of status epilepticus. Semin Neurol. 2008 Jul;28(3):342–54.
8. Bergin PS, Brockington A, Jayabal J, Scott S, Litchfield R, Roberts L, et al. Status epilepticus in Auckland, New Zealand: Incidence, etiology, and outcomes. Epilepsia. 2019 Aug;60(8):1552–64.
9. Neligan A, Walker MC. Falling status epilepticus mortality rates in England and Wales: 2001-2013? Epilepsia. 2016 Jul;57(7):e121-4.
10. Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology. 1998 Mar;50(3):735–41.
11. Reddy Y, Balakrishna Y, Mubaiwa L. Convulsive status epilepticus in a quaternary hospital paediatric intensive care unit (PICU) in South Africa: An 8 year review. Seizure. 2017 Oct;51:55–60.
12. Wagenaar BH, Cumbe V, Raunig-Berho M, Rao D, Kohrt BA, Stergachis A, et al. Outpatient Mental Health Services in Mozambique: Use and Treatments. Psychiatr Serv. 2016 Jun;67(6):588–90.
13. Murthy JMK, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia. 2007 Dec;48(12):2217–23.
14. McTague A MT, Appleton R. Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev [Internet]. 2018;(1). Available from: https://doi.org//10.1002/14651858.CD001905.pub3
15. Hassan H, Rajiv KR, Menon R, Menon D, Nair M, Radhakrishnan A. An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries. Epileptic Disord. 2016 Jun;18(2):163–72.
16. Chin RFM, Verhulst L, Neville BGR, Peters MJ, Scott RC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1584–8.
17. Hussain N, Appleton R, Thorburn K. Aetiology, course and outcome of children admitted to paediatric intensive care with convulsive status epilepticus: A retrospective 5-year review. Seizure [Internet]. 2007;16(4):305–12. Available from: http://www.sciencedirect.com/science/article/pii/S1059131107000064
18. Eriksson KJ, Koivikko MJ. Status epilepticus in children: aetiology, treatment, and outcome. Dev Med Child Neurol. 1997 Oct;39(10):652–8.
19. Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology [Internet]. 2010;74(8):636–42. Available from: https://n.neurology.org/content/74/8/636
20. Chegondi M, Garland MM, Sendi P, Jayakar AR, Totapally BR. Course and Outcome of Children with Convulsive Status Epilepticus Admitted to a Pediatric Intensive Care Unit. Cureus. 2019 Apr;11(4):e4471.
21. Kariuki SM, Kakooza-Mwesige A, Wagner RG, Chengo E, White S, Kamuyu G, et al. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy. Neurology. 2015 May;84(18):1838–45.
22. Asadi-Pooya AA, Poordast A. Etiologies and outcomes of status epilepticus in children. Epilepsy Behav [Internet]. 2005;7(3):502–5. Available from: http://www.sciencedirect.com/science/article/pii/S1525505005002635
23. Jayalakshmi S, Ruikar D, SudhindraVooturi, Alladi S, Sahu S, Kaul S, et al. Determinants and predictors of outcome in super refractory status epilepticus—A developing country perspective. Epilepsy Res [Internet]. 2014;108(9):1609–17. Available from: http://www.sciencedirect.com/science/article/pii/S0920121114002198
24. Halawa EF, Draz I, Ahmed D, Shaheen HA. Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital. J Child Neurol [Internet]. 2015;30(13):1736–42. Available from: https://doi.org/10.1177/0883073815579706
25. Ferlisi M, Hocker S, Trinka E, Shorvon S. Etiologies and characteristics of refractory status epilepticus cases in different areas of the world: Results from a global audit. Epilepsia. 2018 Oct;59 Suppl 2:100–7.
26. Sinha S, Prashantha DK, Thennarasu K, Umamaheshwara Rao GS, Satishchandra P. Refractory status epilepticus: a developing country perspective. J Neurol Sci. 2010 Mar;290(1–2):60–5.
27. Alvarez V, Lee JW, Westover MB, Drislane FW, Novy J, Faouzi M, et al. Therapeutic coma for status epilepticus: Differing practices in a prospective multicenter study. Neurology. 2016 Oct;87(16):1650–9.
28. Dham BS, Hunter K, Rincon F. The epidemiology of status epilepticus in the United States. Neurocrit Care. 2014 Jun;20(3):476–83.
29. Sculier C, Gaínza-Lein M, Sánchez Fernández I, Loddenkemper T. Long-term outcomes of status epilepticus: A critical assessment. Epilepsia. 2018 Oct;59 Suppl 2(Suppl Suppl 2):155–69.
30. Neligan A, Shorvon SD. Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review. Arch Neurol. 2010 Aug;67(8):931–40.
31. Riviello JJJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2006 Nov;67(9):1542–50.
32. Dalziel SR, Borland ML, Furyk J, Bonisch M, Neutze J, Donath S, et al. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. Lancet [Internet]. 2019 May 25;393(10186):2135–45. Available from: https://doi.org/10.1016/S0140-6736(19)30722-6
33. Lyttle MD, Rainford NEA, Gamble C, Messahel S, Humphreys A, Hickey H, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet [Internet]. 2019 May 25;393(10186):2125–34. Available from: https://doi.org/10.1016/S0140-6736(19)30724-X
34. Mpimbaza A, Ndeezi G, Staedke S, Rosenthal PJ, Byarugaba J. Comparison of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children: a randomized clinical trial. Pediatrics. 2008 Jan;121(1):e58-64.
35. Anderson M. Buccal midazolam for pediatric convulsive seizures: efficacy, safety, and patient acceptability. Patient Prefer Adherence. 2013;7:27–34.
36. Ashrafi MR, Khosroshahi N, Karimi P, Malamiri RA, Bavarian B, Zarch AV, et al. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol. 2010 Sep;14(5):434–8.
37. Govoni V, Fallica E, Monetti VC, Guerzoni F, Faggioli R, Casetta I, et al. Incidence of status epilepticus in southern Europe: a population study in the health district of Ferrara, Italy. Eur Neurol. 2008;59(3–4):120–6.
38. Vignatelli L, Rinaldi R, Galeotti M, de Carolis P, D’Alessandro R. Epidemiology of status epilepticus in a rural area of northern Italy: a 2-year population-based study. Vol. 12, European journal of neurology. England; 2005. p. 897–902.
39. Gurcharran K, Grinspan ZM. The burden of pediatric status epilepticus: Epidemiology, morbidity, mortality, and costs. Seizure. 2019 May;68:3–8.
40. Sairanen JJ, Kantanen A-M, Hyppölä HT, Kälviäinen RK. Treatment delay in status epilepticus – more effective prehospital symptom recognition warranted. Scand J Trauma Resusc Emerg Med [Internet]. 2019;27(1):28. Available from: https://doi.org/10.1186/s13049-019-0605-7
41. Hill CE, Parikh AO, Ellis C, Myers JS, Litt B. Timing is everything: Where status epilepticus treatment fails. Ann Neurol. 2017 Aug;82(2):155–65.
42. Sadarangani M, Seaton C, Scott JAG, Ogutu B, Edwards T, Prins A, et al. Incidence and outcome of convulsive status epilepticus in Kenyan children: a cohort study. Lancet Neurol [Internet]. 2008;7(2):145–50. Available from: http://www.sciencedirect.com/science/article/pii/S1474442207703319
References
1. Moshe SL, Perucca E, Ryvlin P, Tomson TT, Moshé SL, Perucca E, et al. Epilepsy: new advances. Lancet (London, England) [Internet]. 2015 Mar 5;385(9971):884–98. Available from: http://dx.doi.org/10.1016/S0140-6736(14)60456-6
2. Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol. 2015 Jun;14(6):615–24.
3. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA. 1993 Aug;270(7):854–9.
4. Scott RC, Surtees RA, Neville BG. Status epilepticus: pathophysiology, epidemiology, and outcomes. Arch Dis Child. 1998 Jul;79(1):73–7.
5. Jafarpour S, Stredny CM, Piantino J, Chapman KE. Baseline and outcome assessment in pediatric status epilepticus. Seizure. 2019 May;68:52–61.
6. Sanchez Fernandez I, Goodkin HP, Scott RC. Pathophysiology of convulsive status epilepticus. Seizure. 2019 May;68:16–21.
7. Arif H, Hirsch LJ. Treatment of status epilepticus. Semin Neurol. 2008 Jul;28(3):342–54.
8. Bergin PS, Brockington A, Jayabal J, Scott S, Litchfield R, Roberts L, et al. Status epilepticus in Auckland, New Zealand: Incidence, etiology, and outcomes. Epilepsia. 2019 Aug;60(8):1552–64.
9. Neligan A, Walker MC. Falling status epilepticus mortality rates in England and Wales: 2001-2013? Epilepsia. 2016 Jul;57(7):e121-4.
10. Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology. 1998 Mar;50(3):735–41.
11. Reddy Y, Balakrishna Y, Mubaiwa L. Convulsive status epilepticus in a quaternary hospital paediatric intensive care unit (PICU) in South Africa: An 8 year review. Seizure. 2017 Oct;51:55–60.
12. Wagenaar BH, Cumbe V, Raunig-Berho M, Rao D, Kohrt BA, Stergachis A, et al. Outpatient Mental Health Services in Mozambique: Use and Treatments. Psychiatr Serv. 2016 Jun;67(6):588–90.
13. Murthy JMK, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia. 2007 Dec;48(12):2217–23.
14. McTague A MT, Appleton R. Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev [Internet]. 2018;(1). Available from: https://doi.org//10.1002/14651858.CD001905.pub3
15. Hassan H, Rajiv KR, Menon R, Menon D, Nair M, Radhakrishnan A. An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries. Epileptic Disord. 2016 Jun;18(2):163–72.
16. Chin RFM, Verhulst L, Neville BGR, Peters MJ, Scott RC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1584–8.
17. Hussain N, Appleton R, Thorburn K. Aetiology, course and outcome of children admitted to paediatric intensive care with convulsive status epilepticus: A retrospective 5-year review. Seizure [Internet]. 2007;16(4):305–12. Available from: http://www.sciencedirect.com/science/article/pii/S1059131107000064
18. Eriksson KJ, Koivikko MJ. Status epilepticus in children: aetiology, treatment, and outcome. Dev Med Child Neurol. 1997 Oct;39(10):652–8.
19. Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology [Internet]. 2010;74(8):636–42. Available from: https://n.neurology.org/content/74/8/636
20. Chegondi M, Garland MM, Sendi P, Jayakar AR, Totapally BR. Course and Outcome of Children with Convulsive Status Epilepticus Admitted to a Pediatric Intensive Care Unit. Cureus. 2019 Apr;11(4):e4471.
21. Kariuki SM, Kakooza-Mwesige A, Wagner RG, Chengo E, White S, Kamuyu G, et al. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy. Neurology. 2015 May;84(18):1838–45.
22. Asadi-Pooya AA, Poordast A. Etiologies and outcomes of status epilepticus in children. Epilepsy Behav [Internet]. 2005;7(3):502–5. Available from: http://www.sciencedirect.com/science/article/pii/S1525505005002635
23. Jayalakshmi S, Ruikar D, SudhindraVooturi, Alladi S, Sahu S, Kaul S, et al. Determinants and predictors of outcome in super refractory status epilepticus—A developing country perspective. Epilepsy Res [Internet]. 2014;108(9):1609–17. Available from: http://www.sciencedirect.com/science/article/pii/S0920121114002198
24. Halawa EF, Draz I, Ahmed D, Shaheen HA. Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital. J Child Neurol [Internet]. 2015;30(13):1736–42. Available from: https://doi.org/10.1177/0883073815579706
25. Ferlisi M, Hocker S, Trinka E, Shorvon S. Etiologies and characteristics of refractory status epilepticus cases in different areas of the world: Results from a global audit. Epilepsia. 2018 Oct;59 Suppl 2:100–7.
26. Sinha S, Prashantha DK, Thennarasu K, Umamaheshwara Rao GS, Satishchandra P. Refractory status epilepticus: a developing country perspective. J Neurol Sci. 2010 Mar;290(1–2):60–5.
27. Alvarez V, Lee JW, Westover MB, Drislane FW, Novy J, Faouzi M, et al. Therapeutic coma for status epilepticus: Differing practices in a prospective multicenter study. Neurology. 2016 Oct;87(16):1650–9.
28. Dham BS, Hunter K, Rincon F. The epidemiology of status epilepticus in the United States. Neurocrit Care. 2014 Jun;20(3):476–83.
29. Sculier C, Gaínza-Lein M, Sánchez Fernández I, Loddenkemper T. Long-term outcomes of status epilepticus: A critical assessment. Epilepsia. 2018 Oct;59 Suppl 2(Suppl Suppl 2):155–69.
30. Neligan A, Shorvon SD. Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review. Arch Neurol. 2010 Aug;67(8):931–40.
31. Riviello JJJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2006 Nov;67(9):1542–50.
32. Dalziel SR, Borland ML, Furyk J, Bonisch M, Neutze J, Donath S, et al. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. Lancet [Internet]. 2019 May 25;393(10186):2135–45. Available from: https://doi.org/10.1016/S0140-6736(19)30722-6
33. Lyttle MD, Rainford NEA, Gamble C, Messahel S, Humphreys A, Hickey H, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. Lancet [Internet]. 2019 May 25;393(10186):2125–34. Available from: https://doi.org/10.1016/S0140-6736(19)30724-X
34. Mpimbaza A, Ndeezi G, Staedke S, Rosenthal PJ, Byarugaba J. Comparison of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children: a randomized clinical trial. Pediatrics. 2008 Jan;121(1):e58-64.
35. Anderson M. Buccal midazolam for pediatric convulsive seizures: efficacy, safety, and patient acceptability. Patient Prefer Adherence. 2013;7:27–34.
36. Ashrafi MR, Khosroshahi N, Karimi P, Malamiri RA, Bavarian B, Zarch AV, et al. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol. 2010 Sep;14(5):434–8.
37. Govoni V, Fallica E, Monetti VC, Guerzoni F, Faggioli R, Casetta I, et al. Incidence of status epilepticus in southern Europe: a population study in the health district of Ferrara, Italy. Eur Neurol. 2008;59(3–4):120–6.
38. Vignatelli L, Rinaldi R, Galeotti M, de Carolis P, D’Alessandro R. Epidemiology of status epilepticus in a rural area of northern Italy: a 2-year population-based study. Vol. 12, European journal of neurology. England; 2005. p. 897–902.
39. Gurcharran K, Grinspan ZM. The burden of pediatric status epilepticus: Epidemiology, morbidity, mortality, and costs. Seizure. 2019 May;68:3–8.
40. Sairanen JJ, Kantanen A-M, Hyppölä HT, Kälviäinen RK. Treatment delay in status epilepticus – more effective prehospital symptom recognition warranted. Scand J Trauma Resusc Emerg Med [Internet]. 2019;27(1):28. Available from: https://doi.org/10.1186/s13049-019-0605-7
41. Hill CE, Parikh AO, Ellis C, Myers JS, Litt B. Timing is everything: Where status epilepticus treatment fails. Ann Neurol. 2017 Aug;82(2):155–65.
42. Sadarangani M, Seaton C, Scott JAG, Ogutu B, Edwards T, Prins A, et al. Incidence and outcome of convulsive status epilepticus in Kenyan children: a cohort study. Lancet Neurol [Internet]. 2008;7(2):145–50. Available from: http://www.sciencedirect.com/science/article/pii/S1474442207703319
2. Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol. 2015 Jun;14(6):615–24.
3. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA. 1993 Aug;270(7):854–9.
4. Scott RC, Surtees RA, Neville BG. Status epilepticus: pathophysiology, epidemiology, and outcomes. Arch Dis Child. 1998 Jul;79(1):73–7.
5. Jafarpour S, Stredny CM, Piantino J, Chapman KE. Baseline and outcome assessment in pediatric status epilepticus. Seizure. 2019 May;68:52–61.
6. Sanchez Fernandez I, Goodkin HP, Scott RC. Pathophysiology of convulsive status epilepticus. Seizure. 2019 May;68:16–21.
7. Arif H, Hirsch LJ. Treatment of status epilepticus. Semin Neurol. 2008 Jul;28(3):342–54.
8. Bergin PS, Brockington A, Jayabal J, Scott S, Litchfield R, Roberts L, et al. Status epilepticus in Auckland, New Zealand: Incidence, etiology, and outcomes. Epilepsia. 2019 Aug;60(8):1552–64.
9. Neligan A, Walker MC. Falling status epilepticus mortality rates in England and Wales: 2001-2013? Epilepsia. 2016 Jul;57(7):e121-4.
10. Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology. 1998 Mar;50(3):735–41.
11. Reddy Y, Balakrishna Y, Mubaiwa L. Convulsive status epilepticus in a quaternary hospital paediatric intensive care unit (PICU) in South Africa: An 8 year review. Seizure. 2017 Oct;51:55–60.
12. Wagenaar BH, Cumbe V, Raunig-Berho M, Rao D, Kohrt BA, Stergachis A, et al. Outpatient Mental Health Services in Mozambique: Use and Treatments. Psychiatr Serv. 2016 Jun;67(6):588–90.
13. Murthy JMK, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia. 2007 Dec;48(12):2217–23.
14. McTague A MT, Appleton R. Drug management for acute tonic‐clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev [Internet]. 2018;(1). Available from: https://doi.org//10.1002/14651858.CD001905.pub3
15. Hassan H, Rajiv KR, Menon R, Menon D, Nair M, Radhakrishnan A. An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries. Epileptic Disord. 2016 Jun;18(2):163–72.
16. Chin RFM, Verhulst L, Neville BGR, Peters MJ, Scott RC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1584–8.
17. Hussain N, Appleton R, Thorburn K. Aetiology, course and outcome of children admitted to paediatric intensive care with convulsive status epilepticus: A retrospective 5-year review. Seizure [Internet]. 2007;16(4):305–12. Available from: http://www.sciencedirect.com/science/article/pii/S1059131107000064
18. Eriksson KJ, Koivikko MJ. Status epilepticus in children: aetiology, treatment, and outcome. Dev Med Child Neurol. 1997 Oct;39(10):652–8.
19. Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology [Internet]. 2010;74(8):636–42. Available from: https://n.neurology.org/content/74/8/636
20. Chegondi M, Garland MM, Sendi P, Jayakar AR, Totapally BR. Course and Outcome of Children with Convulsive Status Epilepticus Admitted to a Pediatric Intensive Care Unit. Cureus. 2019 Apr;11(4):e4471.
21. Kariuki SM, Kakooza-Mwesige A, Wagner RG, Chengo E, White S, Kamuyu G, et al. Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy. Neurology. 2015 May;84(18):1838–45.
22. Asadi-Pooya AA, Poordast A. Etiologies and outcomes of status epilepticus in children. Epilepsy Behav [Internet]. 2005;7(3):502–5. Available from: http://www.sciencedirect.com/science/article/pii/S1525505005002635
23. Jayalakshmi S, Ruikar D, SudhindraVooturi, Alladi S, Sahu S, Kaul S, et al. Determinants and predictors of outcome in super refractory status epilepticus—A developing country perspective. Epilepsy Res [Internet]. 2014;108(9):1609–17. Available from: http://www.sciencedirect.com/science/article/pii/S0920121114002198
24. Halawa EF, Draz I, Ahmed D, Shaheen HA. Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital. J Child Neurol [Internet]. 2015;30(13):1736–42. Available from: https://doi.org/10.1177/0883073815579706
25. Ferlisi M, Hocker S, Trinka E, Shorvon S. Etiologies and characteristics of refractory status epilepticus cases in different areas of the world: Results from a global audit. Epilepsia. 2018 Oct;59 Suppl 2:100–7.
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