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Ueda T, Nishiyama M, Yamaguchi H, Soma K, Ishida Y, Maruyama A, Nozu K, Nagase H. Efficacy and safety of buccal midazolam for seizures outside the hospital: Real-world clinical experience. Brain Dev 2024:S0387-7604(24)00130-X. [PMID: 39317519 DOI: 10.1016/j.braindev.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/10/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
INTRODUCTION Buccal midazolam (buc MDL) is the first buccal mucosal delivery formulation applied for status epilepticus in Japan. Herein, we aimed to investigate the effectiveness and adverse events of buc MDL as a pre-hospital treatment for epileptic seizures in real-world clinical practice. METHODS This study involved a retrospective review based on medical records. We included children who received buc MDL as pre-hospital treatment for epileptic seizures and were subsequently transported to the emergency department between April 2021 and November 2023. RESULTS This study included 26 patients (136 episodes). The overall efficacy rate, which was defined as seizure cessation within 10 min after buc MDL administration with no recurrence within 30 min, was 43 %. Moreover, 70 % of the episodes did not require additional medications. None of the episodes required bag-mask ventilation or intubation following seizure cessation with buc MDL alone. The efficacy was decreased when buc MDL was administered longer than 15 min from seizure onset. Furthermore, the efficacy did not decrease as long as it was within 0.2-0.5 mg/kg, even if the dose was smaller than the appropriate dose for the specific age. CONCLUSIONS The response rate was significantly higher in episodes where buc MDL was administered within 15 min. Additionally, there was no concern regarding respiratory depression with buc MDL alone.
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Affiliation(s)
- Takuya Ueda
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Hiroshi Yamaguchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kento Soma
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan; Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yusuke Ishida
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Azusa Maruyama
- Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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Thibault C, Pelletier É, Nguyen C, Trottier ED, Doré-Bergeron MJ, DeKoven K, Roy AM, Piché N, Delisle JF, Morin C, Paquette J, Kleiber N. The Three W's of Acetaminophen In Children: Who, Why, and Which Administration Mode. J Pediatr Pharmacol Ther 2023; 28:20-28. [PMID: 36777982 PMCID: PMC9901322 DOI: 10.5863/1551-6776-28.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/25/2022] [Indexed: 02/05/2023]
Abstract
Acetaminophen is one of the oldest medications commonly administered in children. Its efficacy in treating fever and pain is well accepted among clinicians. However, the available evidence supporting the use of acetaminophen's different modes of administration remains relatively scarce and poorly known. This short report summarizes the available evidence and provides a framework to guide clinicians regarding a rational use of acetaminophen in children.
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Affiliation(s)
- Céline Thibault
- Department of Pharmacology and Physiology (CT, NK), Université de Montreal, Montreal, QC, Canada,Research Center (CT, NK), CHU Sainte-Justine, Université de Montreal, Montreal, QC, Canada,Department of Pediatrics (CT, MJDB, NK), CHU Sainte-Justine, Montreal, QC, Canada,Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada
| | - Élaine Pelletier
- Department of Pharmacology and Physiology (CT, NK), Université de Montreal, Montreal, QC, Canada,Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Pharmacy (EP, CN, JFD, CM), CHU Sainte-Justine, Montreal, QC, Canada
| | - Christina Nguyen
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Pharmacy (EP, CN, JFD, CM), CHU Sainte-Justine, Montreal, QC, Canada
| | - Evelyne D. Trottier
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Pediatric Emergency Medicine (EDT), CHU Sainte Justine, Montreal, QC, Canada
| | - Marie-Joëlle Doré-Bergeron
- Department of Pediatrics (CT, MJDB, NK), CHU Sainte-Justine, Montreal, QC, Canada,Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada
| | - Kathryn DeKoven
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Anesthesiology (KD), CHU Sainte-Justine, Montreal, QC, Canada
| | - Anne-Marie Roy
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Nursing (AMR, JP), CHU Sainte-Justine, Montreal, QC, Canada
| | - Nelson Piché
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada
| | - Jean-Francois Delisle
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Pharmacy (EP, CN, JFD, CM), CHU Sainte-Justine, Montreal, QC, Canada
| | - Caroline Morin
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Pharmacy (EP, CN, JFD, CM), CHU Sainte-Justine, Montreal, QC, Canada
| | - Julie Paquette
- Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Nursing (AMR, JP), CHU Sainte-Justine, Montreal, QC, Canada
| | - Niina Kleiber
- Department of Pharmacology and Physiology (CT, NK), Université de Montreal, Montreal, QC, Canada,Research Center (CT, NK), CHU Sainte-Justine, Université de Montreal, Montreal, QC, Canada,Groupe de Gouvernance des Analgésiques (CT, EP, CN, EDT, MJDB, KD, AMR, NP, JFD, CM, JP, NK), Pharmacology Committee, CHU Sainte-Justine, Montreal, QC, Canada,Department of Surgery (NP), CHU Sainte-Justine, Montreal, QC, Canada
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Takase R, Sasaki R, Tsuji S, Uematsu S, Kubota M, Kobayashi T. Benzodiazepine Use for Pediatric Patients With Suspected Nonconvulsive Status Epilepticus With or Without Simplified Electroencephalogram: A Retrospective Cohort Study. Pediatr Emerg Care 2022; 38:e1545-e1551. [PMID: 35947072 DOI: 10.1097/pec.0000000000002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In the present study, we aimed to determine the changes in the administration rate of benzodiazepines for pediatric patients with suspected nonconvulsive status epilepticus (NCSE) before and after the introduction of simplified electroencephalography (sEEG) in the emergency department. METHODS This retrospective cohort study included patients who were younger than 18 years and were admitted to the emergency department from August 1, 2009, to July 31, 2017, with altered level of consciousness and nonpurposeful movement of eyes or extremities after the cessation of convulsive status epilepticus. Patients with apparent persistent convulsions, those who were fully conscious on arrival, and those who were transferred from another hospital were excluded. The patients were categorized into pre and post groups based on the introduction of sEEG, and benzodiazepine administration was compared between the 2 groups. RESULTS During the study period, 464 patients with status epilepticus visited our emergency department and 69 and 93 patients fulfilling the study criteria were categorized into the pre and post groups, respectively. There were no significant differences in patient background characteristics between the 2 groups. Simplified electroencephalography was recorded in 52 patients in the post group. Benzodiazepines were administered in 44 of 69 patients (63.8%) in the pre group and 44 of 93 (47.3%) in the post group, and the benzodiazepine administration rate was significantly decreased after the introduction of sEEG ( P = 0.04). The hospitalization rate was significantly lower in the post group, but there were no significant differences in the rates of intensive care unit admission, reconvulsion after discharge, and final diagnoses between the 2 groups. CONCLUSIONS Simplified electroencephalography might aid in determining the need for anticonvulsant treatment for suspected NCSE in pediatric patients. Albeit not a definitive diagnostic tool, sEEG might be a reliable choice in the evaluation of pediatric patients with suspected NCSE.
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Affiliation(s)
- Ryo Takase
- From the Department of Pediatric Emergency and Transport Services
| | - Ryuji Sasaki
- From the Department of Pediatric Emergency and Transport Services
| | - Satoshi Tsuji
- From the Department of Pediatric Emergency and Transport Services
| | - Satoko Uematsu
- From the Department of Pediatric Emergency and Transport Services
| | | | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
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Tokumoto S, Nishiyama M, Yamaguchi H, Tomioka K, Ishida Y, Toyoshima D, Kurosawa H, Nozu K, Maruyama A, Tanaka R, Iijima K, Nagase H. Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children. BMC Neurol 2022; 22:77. [PMID: 35247987 PMCID: PMC8897930 DOI: 10.1186/s12883-022-02608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background Febrile status epilepticus is the most common form of status epilepticus in children. No previous reports compare the effectiveness of treatment strategies using fosphenytoin (fPHT) or phenobarbital (PB) and those using anesthetics as second-line anti-seizure medication for benzodiazepine-resistant convulsive status epilepticus (CSE). We aimed to examine the outcomes of various treatment strategies for febrile convulsive status epilepticus (FCSE) in a real-world setting while comparing the effects of different treatment protocols and their presence or absence. Methods This was a single-center historical cohort study that was divided into three periods. Patients who presented with febrile convulsive status epilepticus for ≥60 min even after the administration of at least one anticonvulsant were included. During period I (October 2002–December 2006), treatment was performed at the discretion of the attending physician, without a protocol. During period II (January 2007–February 2013), barbiturate coma therapy (BCT) was indicated for FCSE resistant to benzodiazepines. During period III (March 2013–April 2016), BCT was indicated for FCSE resistant to fPHT or PB. Results The rate of electroencephalogram monitoring was lower in period I than period II+III (11.5% vs. 85.7%, p<0.01). Midazolam was administered by continuous infusion more often in period I than period II+III (84.6% vs. 25.0%, p<0.01), whereas fPHT was administered less often in period I than period II+III (0% vs. 27.4%, p<0.01). The rate of poor outcome, which was determined using the Pediatric Cerebral Performance Category scale, was higher in period I than period II+III (23.1% vs. 7.1%, p=0.03). The rate of poor outcome did not differ between periods II and III (4.2% vs. 11.1%, p=0.40). Conclusions While the presence of a treatment protocol for FCSE in children may improve outcomes, a treatment protocol using fPHT or PB may not be associated with better outcomes.
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Seizure action plans in the pediatric population with epilepsy: Uptake, determinants, and parental interest in a mobile application. Epilepsy Behav 2021; 117:107860. [PMID: 33721835 DOI: 10.1016/j.yebeh.2021.107860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Status epilepticus (SE) is a common pediatric neurological emergency that requires timely treatment to minimize morbidity and mortality, yet administration of rescue medications is often delayed and underdosed. Seizure action plans (SAPs) outline the steps that should be taken by parents and caregivers in case of SE in order to optimize patient outcomes. Our study determined the uptake of SAPs in a pediatric population with epilepsy and assessed parental interest in a SAP mobile application. METHODS A survey was distributed to parents of patients with epilepsy aged 1 month to 19 years at British Columbia Children's Hospital. Following chart review, univariate and multivariate analyses were performed to identify variables that predict whether patients have SAPs. A systematic search of available mobile applications for epilepsy management was conducted. RESULTS Of 192 participants, 62% have SAPs. On univariate analysis, history of prior SE and male gender increased likelihood of SAP. On logistic regression, Nagelkerke R2 was 0.204 and our model correctly predicted 82% of patients with SAPs. 83% of parents were interested in a SAP mobile application. There are currently 40 mobile applications available for epilepsy management, but only 15% of respondents reported using them. CONCLUSIONS There is a need to increase the percentage of patients with epilepsy with SAPs, particularly in those at greater risk of SE. Most parents would find a SAP mobile application valuable in their child's epilepsy management. There is a gap between the high parental interest in mobile applications for epilepsy management and their current use of such applications.
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McKenzie KC, Hahn CD, Friedman JN. Emergency management of the paediatric patient with convulsive status epilepticus. Paediatr Child Health 2021; 26:50-66. [PMID: 33552322 DOI: 10.1093/pch/pxaa127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 06/08/2020] [Indexed: 12/20/2022] Open
Abstract
This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.
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Affiliation(s)
- Kyle C McKenzie
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario
| | - Cecil D Hahn
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario
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The effect of early midazolam infusion on the duration of pediatric status epilepticus patients. Seizure 2019; 71:50-55. [DOI: 10.1016/j.seizure.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/14/2019] [Accepted: 06/08/2019] [Indexed: 11/17/2022] Open
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Afifi T, Elessi K, Samaan M, Alaqad A, Abu Elhatal H, Abu-Lamzi A. Management of Epilepsy among Children in the Gaza Strip: A Multicenter Clinical Audit. DUBAI MEDICAL JOURNAL 2019. [DOI: 10.1159/000503028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Au CC, Branco RG, Tasker RC. Management protocols for status epilepticus in the pediatric emergency room: systematic review article. J Pediatr (Rio J) 2017; 93 Suppl 1:84-94. [PMID: 28941387 DOI: 10.1016/j.jped.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/18/2017] [Accepted: 07/23/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. SOURCES Systematic search of national or regional guidelines (January 2000 to February 2017) contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. SUMMARY OF FINDINGS 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11) guidelines recommended phenytoin, but other options were phenobarbital (nine/11), valproic acid (six/11), and either fosphenytoin or levetiracetam (each four/11); third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital). CONCLUSIONS All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery.
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Affiliation(s)
- Cheuk C Au
- Boston Children's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston, United States; Queen Mary Hospital, Department of Paediatric and Adolescent Medicine, Hong Kong, China
| | - Ricardo G Branco
- Cambridge University Hospitals NHS Trust, Paediatric Intensive Care Unit, Cambridge, United Kingdom.
| | - Robert C Tasker
- Boston Children's Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston, United States; Boston Children's Hospital, Department of Neurology, Boston, United States
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Au CC, Branco RG, Tasker RC. Management protocols for status epilepticus in the pediatric emergency room: systematic review article. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [DOI: 10.1016/j.jpedp.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ciccone O, Mathews M, Birbeck GL. Management of acute seizures in children: A review with special consideration of care in resource-limited settings. Afr J Emerg Med 2017; 7:S3-S9. [PMID: 30505668 PMCID: PMC6246874 DOI: 10.1016/j.afjem.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 08/14/2017] [Accepted: 09/15/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION We sought to review recent evidence-based guidelines and where applicable, primary data to extrapolate insights into the appropriate management of acute seizures in children in resource-limited settings. METHODS PubMed and Google scholar searches were conducted with attention to publications from the last three to five years, including a focused search for acute seizure management guidelines relevant to resource limited settings. Since all guidelines to date, except the World Health Organization's, assume ready access to invasive ventilation and advanced diagnostic testing, guidelines and primary data were used to propose management appropriate for resource-limited settings where respiratory suppression from treatment presents a major challenge in management. RESULTS Acute seizures are among the commonest medical emergencies encountered in the African settings. Seizure management must occur simultaneously with the diagnostic assessment, which should include addressing life threatening causes (e.g. hypoglycaemia, malaria) and with attention given to the most likely aetiology in a particular region or setting. For ongoing seizures, initial treatment with benzodiazepines is indicated. There is evidence of efficacy for several agents and delivery modes. Longer-acting antiepileptic drugs (AEDs) should be on hand if acute seizures fail to respond to two doses of benzodiazepines. There is little direct evidence comparing the relative efficacy of different long-acting AEDs for acute seizure management in African children. Findings suggest that generalising data from Western settings, where different aetiologies and risk factors for seizures prevail, may be inappropriate. DISCUSSION Though treatment options and diagnostics may be dictated by available medications and capacity, it is possible for virtually any healthcare setting to develop a relevant and feasible local guideline for seizure management. Clear specifications on when to refer to a higher level of care should be part of the care plan.
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Affiliation(s)
- Ornella Ciccone
- The University of Zambia, School of Medicine, Lusaka, Zambia
- University Teaching Hospital, 1 Nationalist Road, P.O. Box 50440, Ridgeway, Lusaka, Zambia
| | - Manoj Mathews
- University Teaching Hospital, 1 Nationalist Road, P.O. Box 50440, Ridgeway, Lusaka, Zambia
| | - Gretchen L. Birbeck
- Chikankata Epilepsy Care Team, Chikankata Hospital, Private Bag S2, Mazabuka, Zambia
- Strong Epilepsy Center, Department of Neurology, University of Rochester, 265 Crittenden Blvd, Rochester, NY 14641, United States
- Corresponding author.
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Lorazepam v. diazepam for pediatric status epilepticus. CAN J EMERG MED 2016; 18:235-8. [DOI: 10.1017/cem.2015.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clinical questionIs intravenous (IV) lorazepam superior to IV diazepam in the treatment of pediatric status epilepticus?Article chosenChamberlain JM, Okada P, Holsti M, et al. Lorazepam v. diazepam for pediatric status epilepticus: a randomized clinical trial. JAMA 2014;311(16):1652-60.ObjectiveTo determine whether lorazepam has better efficacy and safety than diazepam for treating pediatric status epilepticus.
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Tourigny-Ruel G, Diksic D, Mok E, McGillivray D. Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation. CAN J EMERG MED 2015; 16:304-13. [DOI: 10.2310/8000.2013.131131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ABSTRACTObjective:To evaluate the efficacy and safety of a simple linear midazolam-based protocol for the management of impending status epilepticus in children up to 18 years of age.Methods:This is a descriptive, quality assessment, retrospective chart review of children presenting with the chief complaint of seizure disorder in the emergency department (ED) of a tertiary care pediatric hospital and a triage category of resuscitation or urgent from April 1, 2009, to August 31, 2011. In children with at least one seizure episode in the ED treated according to the linear protocol, three main outcomes were assessed: compliance, effectiveness, and complications.Results:Of the 128 children meeting the above study criteria, 68 had at least one seizure episode in the ED, and treatment was required to terminate at least one seizure episode in 46 of 68 patients (67.6%). Fifty-five seizure episodes were treated in the 46 patients: 51 of 55 seizure episodes were treated with midazolam (92.7%) and 4 of 55 with lorazepam or diazepam (7.3%). Of those treated with midazolam, 86.3% (44 of 51) were successfully treated with one or two doses of midazolam. The median seizure duration for all treated patients was 6 minutes. Of the 42 patients treated with midazolam, 7 required either continuous positive airway pressure or intubation, and two patients were treated for hypotension. One patient died of pneumococcal meningitis.Conclusion:This simple linear protocol is an effective and safe regimen for the treatment of impending status epilepticus in children.
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Vlaskamp DRM, Brouwer OF, Callenbach PMC. Treatment of prolonged convulsive seizures in children; a single centre, retrospective, observational study. Eur J Paediatr Neurol 2014; 18:663-9. [PMID: 24908194 DOI: 10.1016/j.ejpn.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 04/05/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate treatment of children with Prolonged Convulsive Seizures (PCS) at the University Medical Centre Groningen (UMCG). MATERIAL AND METHODS PCS were identified from an UMCG database of children with epilepsy aged <18 years who had their first (a)febrile seizure between 2000 and 2010. PCS were included if they lasted ≥10 min and occurred between January 2000 and October 2012 in children aged >1 month. Order, timing, and location of treatment were analysed. Treatment of PCS before and after 2005 was compared with recommendations from a Dutch 2005 treatment guideline for Convulsive Status Epilepticus (CSE) in children aged >1 month. RESULTS 269 PCS occurring in 102 children were included (53.9% male, median age 2.8 years; range 0.1-13.7 years). Seventy episodes concerned a first PCS. Most first and subsequent PCS started outside the hospital (78.6% and 82.4%, respectively) and lasted 10-30 min (42.4% and 51.4%, respectively). Cessation occurred after two administrations of any therapy in first (median, range 0-7) and subsequent PCS (median, range 0-10). First treatment choice was rectal diazepam in first (59.6%) and subsequent (43.9%) PCS, but since 2006 a trend towards buccal midazolam was observed in subsequent PCS. Clonazepam was frequently used as second treatment choice in first (43.8%) and subsequent (27.3%) PCS, although not mentioned in the guideline. CONCLUSION In our study cohort rectal diazepam is still first choice in the management of PCS despite proven superior efficacy of buccal midazolam. Clonazepam is frequently used although it is not formally recommended in a Dutch guideline.
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Affiliation(s)
- Danique R M Vlaskamp
- Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands
| | - Oebele F Brouwer
- Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands
| | - Petra M C Callenbach
- Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands.
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Osborne A, Taylor L, Reuber M, Grünewald RA, Parkinson M, Dickson JM. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines. Seizure 2014; 24:82-7. [PMID: 25264355 DOI: 10.1016/j.seizure.2014.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/08/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. METHODS Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. RESULTS Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. CONCLUSION The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated.
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Affiliation(s)
- Andrew Osborne
- Academic Unit of Primary Medical Care, The Medical School, The University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, South Yorkshire, United Kingdom.
| | - Louise Taylor
- Academic Unit of Primary Medical Care, The Medical School, The University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, South Yorkshire, United Kingdom.
| | - Markus Reuber
- Academic Neurology Unit, The University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, South Yorkshire, United Kingdom.
| | - Richard A Grünewald
- Academic Neurology Unit, The University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, South Yorkshire, United Kingdom.
| | - Martin Parkinson
- Yorkshire Ambulance Service NHS Trust, Springhill 2, Brindley Way, Wakefield 41 Business Park, Wakefield WF2 0XQ, West Yorkshire, United Kingdom.
| | - Jon M Dickson
- Academic Unit of Primary Medical Care, The Medical School, The University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, South Yorkshire, United Kingdom.
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Woolfall K, Young B, Frith L, Appleton R, Iyer A, Messahel S, Hickey H, Gamble C. Doing challenging research studies in a patient-centred way: a qualitative study to inform a randomised controlled trial in the paediatric emergency care setting. BMJ Open 2014; 4:e005045. [PMID: 24833694 PMCID: PMC4025463 DOI: 10.1136/bmjopen-2014-005045] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To inform the design of a randomised controlled trial (called EcLiPSE) to improve the treatment of children with convulsive status epilepticus (CSE). EcLiPSE requires the use of a controversial deferred consent process. DESIGN Qualitative interview and focus group study. SETTING 8 UK support groups for parents of children who have chronic or acute health conditions and experience of paediatric emergency care. PARTICIPANTS 17 parents, of whom 11 participated in telephone interviews (10 mothers, 1 father) and 6 in a focus group (5 mothers, 1 father). 6 parents (35%) were bereaved and 7 (41%) had children who had experienced seizures, including CSE. RESULTS Most parents had not heard of deferred consent, yet they supported its use to enable the progress of emergency care research providing a child's safety was not compromised by the research. Parents were reassured by tailored explanation, which focused their attention on aspects of EcLiPSE that addressed their priorities and concerns. These aspects included the safety of the interventions under investigation and how both EcLiPSE interventions are used in routine clinical practice. Parents made recommendations about the appropriate timing of a recruitment discussion, the need to individualise approaches to recruiting bereaved parents and the use of clear written information. CONCLUSIONS Our study provided information to help ensure that a challenging trial was patient centred in its design. We will use our findings to help EcLiPSE practitioners to: discuss potentially threatening trial safety information with parents, use open-ended questions and prompts to identify their priorities and concerns and clarify related aspects of written trial information to assist understanding and decision-making.
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Affiliation(s)
- Kerry Woolfall
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Lucy Frith
- Department of Health Service Research, University of Liverpool, Liverpool, UK
| | - Richard Appleton
- The Roald Dahl EEG Unit, Paediatric Neurosciences Foundation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Anand Iyer
- The Roald Dahl EEG Unit, Paediatric Neurosciences Foundation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Shrouk Messahel
- Department of Paediatric Emergency Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Helen Hickey
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Carrol Gamble
- Department of Biostatistics, University of Liverpool, Liverpool, UK
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Capovilla G, Beccaria F, Beghi E, Minicucci F, Sartori S, Vecchi M. Treatment of convulsive status epilepticus in childhood: Recommendations of the Italian League Against Epilepsy. Epilepsia 2013; 54 Suppl 7:23-34. [DOI: 10.1111/epi.12307] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Giuseppe Capovilla
- Child Neuropsychiatry Department; Epilepsy Center; C. Poma Hospital; Mantua Italy
| | - Francesca Beccaria
- Child Neuropsychiatry Department; Epilepsy Center; C. Poma Hospital; Mantua Italy
| | - Ettore Beghi
- Department of Neuroscience; IRCCS-Institute of Pharmacological Research “Mario Negri”; Milan Italy
| | - Fabio Minicucci
- Clinical Neurophysiology; San Raffaele Hospital; Milan Italy
| | - Stefano Sartori
- Pediatric Neurology and Clinical Neurophysiology Unit; Department of Pediatrics; University of Padova; Padova Italy
| | - Marilena Vecchi
- Pediatric Neurology and Clinical Neurophysiology Unit; Department of Pediatrics; University of Padova; Padova Italy
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