INTRODUCTION

Status epilepticus (SE), a neurologic emergency, frequently affects kids. It is defined as the occurrence of recurring epileptic seizures with insufficiently long interepisode intervals (at least 30 minutes) to produce a stable and durable epileptic condition. SE may result from any acute insult to the central nervous system, or it may be an undiagnosed form of epilepsy. In some cases, SE is a child's first unannounced seizure who had previously been healthy [1-3]. According to the recently updated definition, T1 and T2 are the two time-point markers for SE. T1 is the moment in time at which the therapy should start. For the convulsive kind of SE, T1 lasts for 5 min; however, there is a strong likelihood that the seizures will last longer than 5 min. T2, which continues to last for 30 min, is the time point after which seizures may have long-term effects. The ILAE model leads to the conclusion that the type of SE largely determines the urgency of management time or intervention time. In order to apply this term, one must be aware of the significance of time variability [4-6].

Epilepsy occurs in infants aged 1 to 12 months at a prevalence of 144 per 100,000 person-years worldwide, and in children aged 0 to 5, it occurs at a rate of 58 per 100,000 (1–10). Saudi Arabia has few studies on the subject, and the majority of available data was provided by hospitals, which may not accurately reflect the true prevalence of the condition. In one community-based investigation, it was found that Saudi Arabia's prevalence of epilepsy was comparable to that of Western nations (6.24 per 1000 people) [7-9].

According to additional research, the prevalence rate of active epilepsy in Saudi Arabia is 6.54/1,000 (95% CI 5.48–7.60), with a generalized onset accounting for the majority of cases. Major neurological disorders are the most prevalent chronic pediatric illnesses in Saudi Arabia, where the incidence rate of epilepsy is 8.8 per 10000, with men being more afflicted. The quality of life (QOL) of many epilepsy patients is impacted by concurrent physical or mental health conditions [10, 11].

In terms of socioeconomic factors, it has been found that developing nations have a higher prevalence of SE than developed nations. Due to inadequate health care infrastructure, sustainable management practices, reduced hygienic conditions, and limited resources, SE is more common, which is also reflected in developing countries' higher mortality indices. According to the information that is currently accessible, 80 percent of SE patients live in poor nations and number close to 50 million [12-14].

The key factor preventing seizures from ending is an imbalance between the excitatory glutamate-mediated system and the inhibitory GABA (gamma-aminobutyric acid) route. During SE, the inhibitory systems are either temporarily impaired, permanently destroyed, or both, causing an extended period of epileptic bursting [15].

Convulsive status epilepticus (CSE) and non-convulsive status epilepticus are the two forms of status epilepticus that are recognized clinically (NCSE). Pediatric emergencies typically involve CSE1, but in recent years, as EEG monitoring has become more widely used, NCSE has been increasingly discovered. NCSE could signal a worse prognosis 8. Only a few studies from Saudi Arabia have been recorded. Mah et al. discovered that 28% of hospitalized pediatric seizure episodes were caused by SE in research conducted in Saudi Arabia 9. In addition, there are other SE etiologic classifications. The Maytal et al. categorization of idiopathic, acute symptomatic, remote symptomatic, febrile, and progressive encephalopathy is the most widely used one [16-19].

Evaluation and treatment of epilepsy in pediatric children is done mainly by the neurologist. The key to evaluating epilepsy, as with many other medical conditions, is collecting a thorough medical history. The history data includes the history of the seizures, any medications used, comorbidities, and the usage of alcohol or any illicit substance. It's also crucial to consider any past malignancies or immunosuppression. The biomarker electroencephalography (EEG) is used to diagnose epilepsy. Additionally, electrolytes should be taken, and lumbar puncture should be addressed in patients who have a fever. Imaging is recommended if a patient has a history of severe head trauma, malignancy, fever, recurrent headaches, and anticoagulation, is over 40 years old, or has focal seizures, and there is a suspicion of an acute intracranial phase [20, 21].

As primary or supplementary treatments, a wide variety of substances may be useful in the treatment of epilepsy. The decision may be made in consultation with a neurologist and may be influenced by potential side effects. According to how they work, medications for epilepsy can be divided into GABA receptor agonists and sodium channel blockers (carbamazepine, oxcarbazepine, phenytoin, lamotrigine, and lacosamide) or benzodiazepine and barbiturates. Other medications with similar mechanisms include glutamate antagonists like topiramate, felbamate, and perampanel, GABA reuptake inhibitors like tiagabine, inhibitors of GABA-transaminase like vigabatrin, and medications with other mechanisms including gabapentin, pregabalin, and valproic acid. The most common category of management medications includes benzodiazepines including lorazepam, midazolam, and diazepam. Second-class epileptic medications include phenytoin and phenobarbital [22, 23].

Study Objectives

Based on current findings in the medical literature, this systematic review aimed to review the published literature of the updates in epidemiology of Status epilepticus in pediatric patients in Saudi Arabia.

MATERIALS AND METHODS

Study Design

Simple Review Article.  

Study Duration

Data will be collected during the period from 1– 31 April, 2022.

Data Collection

Because they are reliable sources, PubMed and EBSCO Information Services will be used as the search databases for the publications used in the study. The National Center for Biotechnology Information (NCBI), a division of the United States National Library of Medicine, created PubMed, one of the biggest digital libraries on the Internet. The creation of the essay drew on material on neurological illnesses, status epilepticus, and other subjects. Titles and an examination of the abstracts were used to filter the fundamental papers.

Inclusion Criteria

Status epilepticus (SE), seizures, mental health issues, and GABA receptors were among the project's required themes, and these publications were chosen based on their applicability to the research.

Exclusion Criteria

All other publications without one of these subjects as their main goal, as well as any reruns of research and reviews of studies, were disregarded.

Statistical Analysis

The data will not be analyzed by any program. The information was taken from a certain form that includes the publication's title, author's name, objective, summary, results, and outcomes. To verify validity and reduce errors, each member's results underwent a second revision.

In order to ensure that the studies we enroll are relevant to the goal of our study and to prevent or reduce errors in the results, studies were double-reviewed and their results were examined during the article selection process.

RESULTS AND DISCUSSION

A total of 105 studies were found after searching the aforementioned databases, which were then used for title screening. 32 of them were excluded after 63 of them were included for abstract screening. The full texts of the remaining 31 publications were examined. Seven studies were enrolled for final data extraction, which includes 23 papers that were excluded as a result of the full-text revision (Table 1).

Two of the four hospital-based studies were carried out in Jeddah and the other two in Riyadh. Only 37% of SE episodes had a correct initial diagnosis, and only 31% of SE episodes as a whole received the appropriate AED medication, according to a study from Jeddah by Mah et al. [24], while 70% of non-SE episodes received the appropriate AED treatment. The results demonstrated that inadequate AED treatment was caused by the use of multiple doses of benzodiazepines, the lack of second- or third-line medicines, or the delayed delivery of second- and third-line pharmaceuticals. While Alyoubi, Reem et al. [25] also in Jeddah reported that a febrile seizure was the most frequent cause of convulsive status epilepticus, followed by electrolyte imbalance and hydrocephalus.

Alotaibi, Badriyah et al. [26] also reported that in comparison to patients who followed the BNF guideline, the group who followed the standard practice was shown to have a higher rate of reported adverse effects. According to this study's findings, titrating antiepileptic medications are harmful to children. Hommady, Raid Harb et al. [27] showed that Mah conducted the final Saudi Arabian study to look into pediatric SE in 1999. In comparison to this analysis, Mah's study revealed a comparable demographic distribution by sex and history of epilepsy. The distribution of etiology varied, nevertheless. Instead of only 5% in Mah's study, this study discovered that 40% of patients had a remote clinical etiology.  The acute symptomatic and febrile etiologies of SE were previously determined to be the most common causes of SE, but in this analysis, they only accounted for 8.6% and 14.7%, respectively.

Jafarpour, Saba et al. [28] Using the questionnaire reported that Pediatric SE has a comparatively low mortality rate, but morbidity is more problematic. It has been shown that the underlying cause of SE is a highly important predictor of the outcome after SE; hence, there is a need for high-quality long-term data looking at QoL, neuroimaging, the use of continuous infusions, and the cognitive and behavioral outcomes of children who suffer SE. Similar findings were found in a second questionnaire by Horaib, Wesal, and colleagues [29]. More frequent seizures, the number of fears, concerns, and worries that patients and caregivers had, and prolonged treatment duration all had a negative impact on quality of life, while better family states and being male had a positive impact. Another questionnaire targeting the children and their mothers was also conducted by Bahkali MA, Choudry et al. [30] which showed that 40% of mothers believed that their epileptic kid could hurt themselves during an epileptic attack, and 58% said that their children need constant supervision out of concern for harm or injury. 71% of the families had been to Raqi (those who utilize the Quran to heal epileptics), and 4% had been to Sorcerer (persons who use magic for treatment). Due to their busy schedules with child health care, 36% of moms reported that they always struggled to find time for their own needs. 59% said they were generally happy, and 50% of moms said they would like to know what to do in the event of an epileptic seizure.