Emergency management of febrile status epilepticus: Results of the FEBSTAT study

Abstract

Objective Treatment of seizures varies by region with no standard emergency treatment protocol. Febrile status epilepticus (FSE) is often a child’s first seizure; therefore, families are rarely educated about emergency treatment. Methods From 2002 to 2010, 199 subjects, age 1 month to 6 years, were recruited as part of a prospective, multicenter study of consequences of FSE. FSE was defined as a febrile seizure or series of seizures lasting >30 minutes. The patients’ charts were reviewed. No standardized treatment protocol was implemented for this observational study. Results 179 received at least one antiepileptic drug (AED) to terminate FSE and more than one AED was required in 140 patients (70%). Median time from the seizure onset to first AED by EMS or ED was 30 minutes. Mean seizure duration was 81 minutes for subjects given medication prior to ED and 95 minutes for those who did not (p=0.1). Median time from the first dose of AED to end of seizure was 38 minutes. Initial dose of lorazepam or diazepam was suboptimal in 32 of 166 patients (19%). Ninety-five (48%) subjects received respiratory support by EMS or ED. Median seizure duration for respiratory support group was 83 minutes; for non-respiratory support group was 58 minutes (p-value < 0.001). Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration. Significance FSE rarely stops spontaneously, is fairly resistant to medications and even with treatment persists for a significant period of time. The total seizure duration is composed of two separate factors; the time from seizure onset to AED initiation, and the time from first AED to seizure termination. Earlier onset of treatment results in shorter total seizure duration. A standard pre-hospital treatment protocol should be used nationwide and education of EMS responders is necessary.

Risk of convulsive epilepsy following acute seizures in Kenyan children

“…After two doses of diazepam and no clinical improvement, either phenobarbital 15 mg/kg or phenytoin 20 mg/kg, depending on what was available, was infused intravenously over 20 min for continuing seizures according to local and international recommendations for management of acute seizures 23, 24…”

Hippocampal Sclerosis and Febrile Status Epilepticus

“…The relationship of these findings to temporal lobe epilepsy requires longer follow-up. neurosurgeon, and associates at Maudsley Hospital, London, UK, recorded the pathological findings in 100 consecutive surgical patients with temporal lobe epilepsy and found a possible association between mesial temporal sclerosis and febrile convulsions in childhood [2]. Sixty years later we are still uncertain of the exact relationship between temporal lobe epilepsy and febrile seizures.…”

“…Delay in AED administration may lead to prolonged FSE and an associated increased risk of respiratory distress. Early treatment of seizures with benzodiazepines does not increase the need for prehospital or ED intubation and respiratory support [1] but rather, results in shorter total seizure duration [2].…”

Lorazepam vs Diazepam for Status Epilepticus

“…The FEBSTAT study of the emergency management of febrile status epilepticus finds that the earlier the onset of treatment, the shorter the total seizure duration and better the outcome [4]. A comparison of buccal or intranasal midazolam vs intravenous or rectal diazepam found that non-IV midazolam was as effective as IV diazepam, and buccal midazolam was superior to rectal diazepam in achieving seizure control; and respiratory complications requiring intervention were similar, regardless of administration route [5].…”