IN WHOM DOES STATUS EPILEPTICUS OCCUR - AGE-RELATED DIFFERENCES IN CHILDREN

Purpose: Status epilepticus (SE) is an uncommon but potentially life-t hreatening seizure. It is most common in children. Little is known abo ut the differences within the pediatric age group in terms of the type of patient seen with SE. Methods: We analyzed the records of 394 chil dren aged 1 month to 16 years who were part of two large studies of pe diatric SE conducted in Bronx, New York, and Richmond, Virginia. The 3 94 children had a mean age of 4.4 years and included 349 (89%) with an initial episode of SE. Results: Status epilepticus was most common in younger children with >40% of cases occurring in those younger than 2 years. The distribution of causes was highly age dependent. More than 80% of children younger than 2 years had SE of febrile or acute sympt omatic origin, whereas cryptogenic and remote symptomatic causes were most common in older children (p < 0.001). One hundred fifty-eight (40 %) of the cases were known to be previously neurologically abnormal, i ncluding 35 (21%) of 169 younger than ape 2 years and 123 (55%) of 225 older than 2 years (p < 0.001). One hundred seventy-seven (45%) child ren had a history of seizures including 142 (41%) of the 349 children with a first episode of SE. A history of seizures was present in 34 (2 0%) of those younger than 2 years and 143 (64%) of those older than 2 years (p < 0.001). The effect of age remained significant even when th e analysis was limited to those with SE of cryptogenic or remote sympt omatic origin. Conclusions: There is a strong effect of age on the fre quency and etiology of SE, as well as on the type of child who has SE. In young children, SE occurs primarily in children who are neurologic ally normal and with no history of unprovoked seizures. In older child ren, SE occurs primarily in those who are known to have prior unprovok ed seizures and who are often also neurologically abnormal.