Pediatric Intensive Care Treatment of Uncontrolled Status Epilepticus

Wilkes, R D; Tasker, Robert C.

doi:10.1016/j.ccc.2012.11.007

Cited by 51 publications

(66 citation statements)

References 69 publications

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“…If seizures persist, moving to the next AED class in the sequence should be done by 10 minutes and, if repeated AED doses do not control SE, the initiation of anesthetic dosing via continuous infusions should be started by 30-70 minutes of seizure onset. 14,16 Timely AED administration and rapidly moving along the sequence of AED classes are intended to stop seizures as quickly as possible. Basic and clinical research suggest that longer-duration seizures are more treatmentresistant and are associated with a worse outcome.…”

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confidence: 99%

Time from convulsive status epilepticus onset to anticonvulsant administration in children

et al. 2015

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Objective: To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED).Methods: This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE. Results:We enrolled 81 patients (44 male) with a median age of 3.6 years. The first, second, and third AED doses were administered at a median (p 25 -p 75 ) time of 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes after SE onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2-3) doses of benzodiazepines were administered before switching to nonbenzodiazepine AEDs. The first and second doses of nonbenzodiazepine AEDs were administered at 69 (40-120) minutes and 120 (75-296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5-15) minutes and 16 (10-40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset). Conclusions:The time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the prehospital and in-hospital settings. Status epilepticus (SE) is one of the most common pediatric neurologic emergencies.1 It has a mortality of 0%-3% 2-7 and morbidity that includes cognitive and neurodevelopmental impairments, epilepsy, and recurrent SE.2,8-10 SE is often refractory to the initial antiepileptic drugs (AEDs), 11,12 and refractory SE is associated with poor outcome. 12 Patient age, etiology, and SE duration all affect outcome, 5,9,13 but only SE duration is a potentially modifiable factor by rapid AED treatment. By convention, the treatment of convulsive SE is a sequence of AEDs, typically

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confidence: 99%

Time from convulsive status epilepticus onset to anticonvulsant administration in children

et al. 2015

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“…Both adults [13][14][15][16][17] and children [17][18][19][20] receive antiepileptic drugs (AEDs) later than recommended by most SE guidelines. [21][22][23] Most episodes of pediatric SE occur in children with no history of seizures. 1,19 However, there are no data on whether having a history of seizures or SE results in more timely treatment-including initial abortive medication and escalation of therapies-and better outcomes.…”

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confidence: 99%

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

et al. 2017

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Objective: To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).Methods: This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE.Results: We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.2 (1.3-9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [ Conclusions: Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication. Neurology ® 2017;88:386-394 GLOSSARY AED 5 antiepileptic drug; BZD 5 benzodiazepine; EMS 5 emergency medical services; ICU 5 intensive care unit; p 25 -p 75 5 25th-75th percentile; pSERG 5 pediatric Status Epilepticus Research Group; rSE 5 refractory status epilepticus; SE 5 status epilepticus.Convulsive status epilepticus (SE) is one of the most common pediatric emergencies. It affects approximately 10-25/100,000 children per year, 1-3 while posing a substantial economic burden to individuals and society. 4,5 Pediatric SE is associated with a short-term mortality of 0%-3% 1,[6][7][8] and long-term mortality of approximately 7%. 9 Survivors often experience both functional and neurobehavioral sequelae 7,8,10 and a reduced quality of life. 11 When SE does not respond to initial medications, it is then considered refractory SE (rSE) and its outcome is markedly worse.

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“…The management of RSE has been reviewed previously in children 89–92 and while there is variability in suggested pathways, all either administer additional anticonvulsants such as phenytoin/fosphenytoin, phenobarbital, valproate sodium, or levetiracetam, or they proceed to pharmacologic coma induction with intravenous or inhaled medications. A survey of 60 experts in SE management conveyed that there was substantial variability in the selected medications which included phenytoin, levetiracetam, valproate, and midazolam.…”

Section: Refractory Status Epilepticusmentioning

confidence: 99%

Status Epilepticus and Refractory Status Epilepticus Management

Abend¹,

Bearden²,

Helbig³

et al. 2014

Seminars in Pediatric Neurology

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Status epilepticus (SE) describes persistent or recurring seizures without a return to baseline mental status, and is a common neurologic emergency. SE can occur in the context of epilepsy or may be symptomatic of a wide range of underlying etiologies. The clinician’s aim is to rapidly institute care that simultaneously stabilizes the patient medically, identifies and manages any precipitant conditions, and terminates seizures. Seizure management involves “emergent” treatment with benzodiazepines followed by “urgent” therapy with other anti-seizure medications. If seizures persist then refractory SE is diagnosed and management options include additional anti-seizure medications or infusions of midazolam or pentobarbital. This paper reviews the management of pediatric SE and RSE.

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Pediatric Intensive Care Treatment of Uncontrolled Status Epilepticus

Cited by 51 publications

References 69 publications

Time from convulsive status epilepticus onset to anticonvulsant administration in children

Time from convulsive status epilepticus onset to anticonvulsant administration in children

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Status Epilepticus and Refractory Status Epilepticus Management

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