Central nervous system infections and status epilepticus association, clinical profile and outcomes in children hospitalized with new-onset acute symptomatic seizures

Abstract

This study investigated the clinical characteristics and risk factors for poor clinical outcomes among children presenting with a first seizure episode to the Emergency Department (ED). This study further assessed the association between convulsive status epilepticus (CSE) and central nervous system (CNS) infections. This was a single-center, cross-sectional study of children admitted to a tertiary pediatric hospital in southern Vietnam between June and October 2024. Propensity score matching (PSM) was applied to balance the baseline characteristics, and logistic regression models were used to identify the determinants of poor clinical outcomes. Of the 2728 ED admissions, 425 children with new-onset seizures met the inclusion criteria. CSE occurred in 52 patients (12.2%). Abnormal cerebrospinal fluid findings suggestive of CNS infections were identified in 49/131 (37.4%) patients who underwent lumbar puncture. Poor outcomes, defined as death or neurological sequelae at discharge, were observed in 11.8% of hospitalized children. Multivariable logistic regression with PSM adjustment demonstrated a significant association between CSE and CNS infections (adjusted odds ratio 30.9 [95% confidence interval 12.4–77.4]; P < .001). The determinants of poor outcomes included focal seizure onset, lower Glasgow Coma Scale scores at admission, delayed presentation from seizure onset to hospitalization, and confirmed CNS infections. These findings highlight the substantial burden of severe neurological complications in children presenting with first-time seizures and underscore the critical role of timely recognition of CSE and CNS infections. This study, based on data from resource-limited hospitals, strengthens diagnostic pathways and informs early management strategies for acute symptomatic seizures in resource-limited settings.