Status Epilepticus

Abstract

Status epilepticus is a serious medical emergency that requires prompt and appropriate intervention. Maintenance of adequate vital function with attention to airway, breathing, and circulation; prevention of systemic complications; and rapid termination of seizures must be coupled with investigating and treating any underlying cause. In most patients with SE, the use of adequate dosages of first-line antiepileptic agents allows for the successful and rapid termination of SE and avoidance of potential neurologic complications. Refractory SE requires more aggressive treatment, often the use of intravenous anesthetic agents and intense monitoring, and therefore must be managed in a pediatric intensive care unit with a multidisciplinary approach. Large, controlled, multicenter, comparative studies are needed urgently to clarify better the optimal management of these patients.

Status epilepticus after a massive intravenous N-acetylcysteine overdose leading to intracranial hypertension and death

“…Intracranial hypertension is a known but infrequent complication of status epilepticus. Brain edema develops during prolonged seizures when cerebral metabolic demands exceed supply, and as a consequence cerebral herniation can develop, 22 which has been reported in animal studies. 23 It is unclear whether a more aggressive treatment of the seizures, including an early endotracheal intubation, earlier phenobarbital administration, and use of barbiturate coma, if needed, could have prevented the fatal outcome in this case.…”

Review of Benzodiazepine use in Children and Adolescents

“…Amongst the most commonly used BDZs for this indication are diazepam, clonazepam, clorazepate and lorazepam. Diazepam is frequently employed in treatment of status epilepticus, prevention of febrile seizures, and tonic-clonic seizures (40,41). Nonetheless, other agents may be equally effective.…”

Status Epilepticus in Children

“…It is estimated that 1.3 to 16% of all patients with epilepsy will develop SE at some point in their lives [2]. Approximately 70% of SE occurs in children less than one year and 75% in less than three years of age [5] and the first episode most commonly occurs around 2.5 years after initial diagnosis [6].…”