Pediatric Status Epilepticus: A Systematic Review of Clinical Pattern, Challenges, and Outcomes
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: Pediatric status epilepticus (SE) is a neurological emergency with substantial risk of death and long-term disability. Clinical patterns and outcomes vary widely across regions, particularly where delayed treatment and limited EEG or ICU access persist, necessitating a consolidated appraisal to inform standardized care. Methods: A PRISMA-guided systematic review of pediatric SE (ages 1 month–18 years) was conducted. Twenty studies met the inclusion criteria for quantitative synthesis (n = 2,910). Data were extracted for demographics, seizure types, etiologies, treatment, complications, and outcomes. For pooled outcomes (mortality, refractoriness, sequelae), random-effects models with Freeman–Tukey transformation were applied, reporting 95 % CIs and heterogeneity (I², τ²). Subgroup analyses compared India vs non-India studies, acute symptomatic vs other etiologies, and refractory vs non-refractory cases. Results: Males comprised 56.7 %; generalized convulsive SE predominated (72.1 %). Acute symptomatic causes (CNS infections, metabolic, hypoxic–ischemic injury) represented 54.3 %, febrile SE 24.3 %. Refractory SE occurred in 26.1 %, super-refractory 3.3 %. Benzodiazepines were the main first-line drugs; escalation commonly involved phenytoin/fosphenytoin, levetiracetam, or valproate, with anesthetic infusions for RSE/SRSE. Pooled mortality approximated 14–15 %, showing high inter-study heterogeneity due to differences in prehospital delay, etiology mix, and ICU availability. Neurological sequelae affected 22–23 % of survivors. Conclusions: Pediatric SE remains a high-stakes emergency. Early benzodiazepine use, rapid escalation, and standardized stepwise protocols are essential. Marked heterogeneity in mortality highlights the need for prehospital training, faster treatment times, and expanded EEG/ICU capacity. Prospective cohorts with uniform outcome metrics and exploration of immunotherapy in NORSE are urgently needed.
DOI: 10.14419/nep9b877
Authors: Dr. Anwita Ramdas Shinde, Dr. Shradha Salunkhe, Dr. Shailaja Mane
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416815762
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