The North London convulsive STatus EPilepticus in childhood Surveillance Study - NLSTEPSS
Convulsive status epilepticus (CSE) is the most common medical neurological emergency in childhood. To ultimately improve the management of CSE, an understanding of its incidence, aetiology, seizure types, treatment and outcome in the general childhood population is required. Using emerging techniques for systematic reviews in observational studies, a systematic review of the epidemiology of status epilepticus was conducted. All eligible studies were based on predominantly or exclusively adult populations. The data from these studies suggest that the epidemiology of CSE in childhood differs from that in adults. Thus, an epidemiological study on CSE in a paediatric population was required. The North London convulsive STatus EPilepticus in childhood Surveillance Study (NLSTEPSS), a prospective study, is the first such study. In NLSTEPSS, children with CSE were identified through a multi-tiered notification system. Data were collected using a standard questionnaire and capture-recapture was used to assess ascertainment. The incidence of CSE in childhood is 18-20/100,000/year (95% CI 17- 23/100,000/yr), with a higher incidence amongst non-white children, children of lower socioeconomic status and younger children. Lack of prehospital treatment, and treatment with more than 2 doses of benzodiazepines independently increase the likelihood of CSE lasting longer than 60 minutes. A third of children with CSE are not given prehospital treatment and only 21% of those treated are given adequate initial doses. Treatment with more than 2 doses of benzodiazepines is associated with respiratory depression. Intravenous lorazepam may be better first line therapy than rectal diazepam and intravenous phenytoin may be better second line therapy than rectal paraldehyde. CSE lasting longer than 60 minutes and CSE associated with respiratory depression independently increase the likelihood of admission to paediatric intensive care (PICU). Thus, strategies to reduce those factors may reduce admissions to PICU. On the basis of the data from NLSTEPSS, treatment guidelines for CSE in childhood may need to be revised and a new treatment guideline is proposed.