Practice Parameter: Diagnostic assessment of the child with status epilepticus (an evidence-based review)

Abstract

Abstract-Objective:To review evidence on the assessment of the child with status epilepticus (SE). Methods: Relevant literature were reviewed, abstracted, and classified. When data were missing, a minimum diagnostic yield was calculated. Recommendations were based on a four-tiered scheme of evidence classification. Results: Laboratory studies (Na ϩϩ or other electrolytes, Ca ϩϩ , glucose) were abnormal in approximately 6% and are generally ordered as routine practice. When blood or spinal fluid cultures were done on these children, blood cultures were abnormal in at least 2.5% and a CNS infection was found in at least 12.8%. When antiepileptic drug (AED) levels were ordered in known epileptic children already taking AEDs, the levels were low in 32%. A total of 3.6% of children had evidence of ingestion. When studies for inborn errors of metabolism were done, an abnormality was found in 4.2%. Epileptiform abnormalities occurred in 43% of EEGs of children with SE and helped determine the nature and location of precipitating electroconvulsive events (8% generalized, 16% focal, and 19% both). Abnormalities on neuroimaging studies that may explain the etiology of SE were found in at least 8% of children. Recommendations: Although common clinical practice is that blood cultures and lumbar puncture are obtained if there is a clinical suspicion of a systemic or CNS infection, there are insufficient data to support or refute recommendations as to whether blood cultures or lumbar puncture should be done on a routine basis in children in whom there is no clinical suspicion of a systemic or CNS infection (Level U). AED levels should be considered when a child with treated epilepsy develops SE (Level B). Toxicology studies and metabolic studies for inborn errors of metabolism may be considered in children with SE when there are clinical indicators for concern or when the initial evaluation reveals no etiology (Level C). An EEG may be considered in a child with SE as it may be helpful in determining whether there are focal or generalized epileptiform abnormalities that may guide further testing for the etiology of SE, when there is a suspicion of pseudostatus epilepticus (nonepileptic SE), or nonconvulsive SE, and may guide treatment (Level C). Neuroimaging may be considered after the child with SE has been stabilized if there are clinical indications or if the etiology is unknown (Level C). There is insufficient evidence to support or refute routine neuroimaging in a child presenting with SE (Level U).

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

“…The assessment of compliance and effectiveness was based on pre-existing and proposed quality assessment indicators for the treatment of pediatric SE that were discussed by experts at a Pediatric Emergency National Advisory Panel held in 2011 (Table 1). [24][25][26][27][28][29][30][31][32] Respiratory depression and hypotension, the two main serious adverse effects following the treatment of SE with benzodiazepines, 20 were used as the two safety outcomes. Respiratory depression was defined as any patient requiring bag/mask ventilation, continuous positive airway pressure (CPAP), or intubation.…”

Effective treatments of prolonged status epilepticus in developing rats

“…SE is associated with high mortality, brain injury and the subsequent development of epilepsy in an age dependent fashion (5). Because SE may have deleterious effects on the brain, it is considered a neurological emergency that needs to be treated as quickly as possible to avoid the detrimental effects (6). The longer SE continues the less likely it will stop (7).…”

Lorazepam v. diazepam for pediatric status epilepticus

“…1 "Early" or "impending" status epilepticus is a continuous or intermittent seizure lasting longer than 5 minutes without full recovery of consciousness between seizures. 1 The annual incidence of status epilepticus is about 10 to 75 per 100,000 2 in developed countries.…”

“…1 "Early" or "impending" status epilepticus is a continuous or intermittent seizure lasting longer than 5 minutes without full recovery of consciousness between seizures. 1 The annual incidence of status epilepticus is about 10 to 75 per 100,000 2 in developed countries. If not managed appropriately, status epilepticus can result in permanent neuronal cell injury and cell loss, in addition to systemic problems such as impaired ventilation, pulmonary aspiration, and metabolic complications.…”