Management of convulsive status epilepticus in children

Yoong, Michael; Chin, Richard; Scott, Rod C.

doi:10.1136/adc.2007.134049

Cited by 27 publications

(15 citation statements)

References 65 publications

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“…Convulsive status epilepticus (CSE) in children is common 1–3 and potentially life‐threatening, 1,4 with high associated morbidity. Guidelines on acute management of CSE 5 focus on drug therapy 6 and seizure termination, but guidance on optimal follow‐up investigations remains unclear 7 . In particular, one investigation frequently considered is the need for and type of neuroimaging.…”

mentioning

confidence: 99%

The role of magnetic resonance imaging in the follow‐up of children with convulsive status epilepticus

Yoong¹,

Madari

Martinos³

et al. 2012

Develop Med Child Neuro

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CSEConvulsive status epilepticus GOSH Great Ormond Street Hospital HIMAL Hippocampal malrotation PFS Prolonged febrile seizure STEPIN Status Epilepticus Imaging and Neurocognitive Study AIM The aim of this study was to determine the yield of magnetic resonance imaging (MRI) after an episode of childhood convulsive status epilepticus (CSE) and to identify the clinical predictors of an abnormal brain scan.METHOD Children were recruited following an episode of CSE from an established clinical network in north London. Eighty children (age range 1mo-16y; 39 males; 41 females) were enrolled and seen for clinical assessment and brain MRI within 13 weeks of suffering from an episode of CSE. Scans were reviewed by two neuroradiologists and classified as normal (normal ⁄ normal-variant) or abnormal (minor ⁄ major abnormality). Factors predictive of an abnormal scan were investigated using logistic regression.RESULTS Eighty children were recruited at a mean of 31.8 days (5-90d) after suffering from CSE.Structural abnormalities were found in 31%. Abnormal neurological examination at assessment (odds ratio [OR] 190.46), CSE that was not a prolonged febrile seizure (OR 77.12), and a continuous rather than an intermittent seizure (OR 29.98) were all predictive of an abnormal scan. No children with previous neuroimaging had new findings that altered their clinical management.INTERPRETATION Brain MRI should be considered for all children with a history of CSE who have not previously undergone MRI, especially those with non-prolonged febrile seizure CSE, those with persisting neurological abnormalities 2 to 13 weeks after CSE, and those with continuous CSE.Convulsive status epilepticus (CSE) in children is common [1][2][3] and potentially life-threatening, 1,4 with high associated morbidity. Guidelines on acute management of CSE 5 focus on drug therapy 6 and seizure termination, but guidance on optimal follow-up investigations remains unclear. 7 In particular, one investigation frequently considered is the need for and type of neuroimaging. Since the outcome is largely dependent on the aetiology, 1,8 determining the underlying diagnosis is important for both treatment and prognosis, and neuroimaging may thus be useful.From historical data, a minimum yield of detectable lesions of 7.8% has been estimated amongst all children with CSE who underwent neuroimaging. 7 In practice, this may be conservative, particularly if imaging is restricted to children at particular risk of structural brain lesions. It would be beneficial to determine yield in the general population of children with CSE and identify risk factors for structural lesions so that unnecessary imaging is avoided and those children likely to benefit are treated appropriately.The Status Epilepticus Imaging and Neurocognitive Study (STEPIN) is a prospective study on the effects of childhood CSE within the first year of suffering from an episode of CSE. In this paper, we report on the clinical and magnetic resonance imaging (MRI) findings within 13 weeks of CSE and on facto...

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mentioning

confidence: 99%

The role of magnetic resonance imaging in the follow‐up of children with convulsive status epilepticus

Yoong¹,

Madari

Martinos³

et al. 2012

Develop Med Child Neuro

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“…The dose of paraldehyde in the current study contrasts with the findings of Chin et al 9 who observed that 46 of 90 doses of paraldehyde were inappropriately low or high (as defined as less than 50% or greater than 150% of the “appropriate” dose of 0.3 ml/kg, respectively). This may in part explain why paraldehyde appeared to be relatively ineffective in terminating seizures in a community study of convulsive status epilepticus and the conclusion that rectal paraldehyde was an unjustified treatment10 and therefore omitted from the treatment protocol for convulsive status epilepticus 11…”

Section: Discussionmentioning

confidence: 99%

Review of the efficacy of rectal paraldehyde in the management of acute and prolonged tonic-clonic convulsions

Rowland

Gill

Stewart

et al. 2009

Archives of Disease in Childhood

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“…Since most seizures start outside of the hospital/clinical setting (Raspall-Chaure et al, 2007), it is imperative that in order to minimise seizure duration, treatment should be started prior to arrival at the hospital (Treiman et al, 1998;Chin et al, 2004a;Chin et al, 2008). Whilst there is clear evidence that intravenous therapy is best (Yoong et al, 2009), pre-hospital treatment S51 Benzodiazepines in children with prolonged seizures by a non-intravenous route is most desirable since intravenous access poses a major challenge in a child experiencing seizures, particularly in children under the age of 5 years, when CSE is most common (Chin et al, 2004b;Chin et al, 2006). Benzodiazepines are the main class of first-line antiepileptic drugs (AEDs) used for the emergency treatment of seizures because they have a rapid onset of action, have good efficacy, and are easy to prepare and administer by non-intravenous routes.…”

Section: Convulsive Status Epileptics (Cse)mentioning

confidence: 99%

“…Whilst there is clear evidence that intravenous therapy is best (Yoong et al ., ), pre‐hospital treatment by a non‐intravenous route is most desirable since intravenous access poses a major challenge in a child experiencing seizures, particularly in children under the age of 5 years, when CSE is most common (Chin et al ., ; Chin et al ., ). Benzodiazepines are the main class of first‐line antiepileptic drugs (AEDs) used for the emergency treatment of seizures because they have a rapid onset of action, have good efficacy, and are easy to prepare and administer by non‐ intravenous routes.…”

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confidence: 99%

What are the best ways to deliver benzodiazepines in children/patients with prolonged convulsive seizures?

Chin

2014

Epileptic Disorders

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Aetiology is the main determinant of morbidity and mortality in convulsive status epilepticus (CSE) but longer seizure durations may also increase risk of worse outcome. Thirty minutes of seizure activity is usually the time period used in longstanding definitions of CSE but it is not acceptable to wait for 30 minutes before treatment. Whilst intravenous therapy is best, pre‐hospital treatment by a non‐intravenous route is most practical in treating children. Benzodiazepines are the main class of first‐line emergency antiepileptic drugs. This review will examine the available data on benzodiazepines according to: stability in the conditions of the emergency room services, drug absorption via non‐intravenous route, clinical efficacy and safety, and ease of delivery and social acceptability.

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Management of convulsive status epilepticus in children

Cited by 27 publications

References 65 publications

The role of magnetic resonance imaging in the follow‐up of children with convulsive status epilepticus

The role of magnetic resonance imaging in the follow‐up of children with convulsive status epilepticus

Review of the efficacy of rectal paraldehyde in the management of acute and prolonged tonic-clonic convulsions

What are the best ways to deliver benzodiazepines in children/patients with prolonged convulsive seizures?

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