Abstracts

This abstract has been invited to present during the Clinical Research platform session

Rationale: Childhood status epilepticus (cSE) is common in sub-Saharan Africa, and cSE is associated with high mortality. We recently determined that the in-hospital mortality among children with SE in Kano, Nigeria was 23%. To address the mortality for cSE in Kano we implemented a published SE treatment guideline (Glauser, et.al., Epilepsy Currents 2016;16(1):48-61), modified for drugs available in northern Nigeria, plus a team-based approach to cSE diagnosis and care in Emergency Pediatric Units (EPUs).

Methods: The Childhood Status Epilepticus and Epilepsy Determinants of Outcome (SEED) team is currently comprised of 10 nurses trained in cSE and the cSE diagnosis and treatment protocol (Figure 1) plus 12 community health workers (CHWs) who completed training in EEG technology and received additional training in the cSE diagnosis and treatment protocol.  The SEED team, comprised of 1 EEG technologist and 1 epilepsy nurse are stationed in the 3 major EPUs in Kano city 24 hours per day, 7 days per week, and are embedded with the EPU physicians and nurses. Children with possible cSE are screened by the SEED team upon arrival to the EPU, with activation of the protocol.  EG-video studies are performed in the EPUs, on all children with diagnosed or suspected cSE.  Midazolam is available in a locked refrigerator in each EPU for rapid availability and is administered by the nurses upon orders given by physicians according to the protocol (Figure 1), with supervision by the SEED pharmacist. EEG-video studies are interpreted remotely by Kano-based EEG readers on call. Children with cSE are enrolled into the SEED cohort study via consent/assent; children who die within 4 hours of arrival to the EPU whose parent/guardian does not refuse consent are considered enrolled for the purposes of the SEED cohort data analysis. The SEED protocol has been approved by the AKTH Ethics Committee in Kano, and by the Vanderbilt IRB in the U.S.

Results: Between August 17, 2021, and June 6, 2022, 288 of 298 children with cSE who were registered with diagnosed cSE were enrolled in the SEED long-term cohort study. Of these 288 children, 39 children died prior to hospital discharge (13.5%), 7 of whom died within 4 hours of arrival to the EPU. Among the 318 EPU visits by the 298 children registered for cSE, including 20 children who had 2 or more visits to the EPU for cSE, 214 continued to have seizures after the stabilization phase and entered Phase 1 of the cSE protocol (Figure 1); 181 of 214 (84.6%) children stopped having seizures after receiving the first dose of a benzodiazepine. Twenty-eight of 33 (84.8%) children who continue seizing after the first dose stopped having seizures after a second dose of the benzodiazepine. Four children continued seizing after Phase 2 of the protocol, while only 1 child continued to seize after Phase 3 of the protocol.

Conclusions: While cSE is associated with a high in-hospital mortality in northern Nigeria, initial analysis of the cohort data document that with implementation of the cSE diagnosis and treatment protocol that the response to the initial benzodiazepine is very good, and the in-hospital mortality has decreased from about 23% to 13.5%.

Funding: NINDS, FIC/NIH (R01 NS118483)