1
|
Sánchez Fernández I, Gaínza-Lein M, Lamb N, Loddenkemper T. Meta-analysis and cost-effectiveness of second-line antiepileptic drugs for status epilepticus. Neurology 2019; 92:e2339-e2348. [DOI: 10.1212/wnl.0000000000007503] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/17/2019] [Indexed: 02/07/2023] Open
Abstract
ObjectiveCompare the cost and effectiveness of nonbenzodiazepine antiepileptic drugs (non-BZD AEDs) for treatment of BZD-resistant convulsive status epilepticus (SE).MethodsDecision analysis model populated with effectiveness data from a systematic review and meta-analysis of the literature, and cost data from publicly available prices. The primary outcome was cost per seizure stopped ($/SS). Sensitivity analyses evaluated the robustness of the results across a wide variation of the input parameters.ResultsWe included 24 studies with 1,185 SE episodes. The most effective non-BZD AED was phenobarbital (PB) with a probability of SS of 0.8 (95% confidence interval [CI]: 0.69–0.88), followed by valproate (VPA) (0.71 [95% CI: 0.61–0.79]), lacosamide (0.66 [95% CI: 0.51–0.79]), levetiracetam (LEV) (0.62 [95% CI: 0.5–0.73]), and phenytoin/fosphenytoin (PHT) (0.53 [95% CI: 0.39–0.67]). In pairwise comparisons, PB was more effective than PHT (p = 0.002), VPA was more effective than PHT (p = 0.043), and PB was more effective than LEV (p = 0.018). The most cost-effective non-BZD AED was LEV (incremental cost-effectiveness ratio [ICER]: $18.55/SS), followed by VPA (ICER: $94.44/SS), and lastly PB (ICER: $847.22/SS). PHT and lacosamide were not cost-effective compared to the other options. Sensitivity analyses showed marked overlap in cost-effectiveness, but PHT was consistently less cost-effective than LEV, VPA, and PB.ConclusionVPA and PB were more effective than PHT for SE. There is substantial overlap in the cost-effectiveness of non-BZD AEDs for SE, but available evidence does not support the preeminence of PHT, neither in terms of effectiveness nor in terms of cost-effectiveness.
Collapse
|
2
|
Prusakov AB, Patel AD, Cole JW. Impact of Obesity on Fosphenytoin Volume of Distribution in Pediatric Patients. J Child Neurol 2018; 33:534-536. [PMID: 29714095 DOI: 10.1177/0883073818770801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The impact of body habitus on fosphenytoin pharmacokinetics is poorly understood in pediatric patients. This retrospective, single-center review examined differences in fosphenytoin volume of distribution (VD) between children with normal and obese body habitus. From 2013 to 2015, patients 2 to 18 years of age who received a loading dose of fosphenytoin were identified. Thirty-seven patients met inclusion criteria. Mean total serum phenytoin concentration was 25.3 ± 6.5 μg/mL in the nonobese group and 29.5 ± 7.6 μg/mL in the obese group ( P = .09). VD was not significantly different between obese and nonobese groups, 0.92 ± 0.26 L/kg and 0.97 ± 0.48 L/kg ( P = .76), respectively. In contrast to adult studies, these data suggest that fosphenytoin dose adjustments for obese children may be unnecessary.
Collapse
Affiliation(s)
| | - Anup D Patel
- 1 Nationwide Children's Hospital, Columbus, OH, USA
| | - Justin W Cole
- 1 Nationwide Children's Hospital, Columbus, OH, USA.,2 Cedarville University School of Pharmacy, Cedarville, OH, USA
| |
Collapse
|
3
|
Towards acute pediatric status epilepticus intervention teams: Do we need “Seizure Codes”? Seizure 2018; 58:133-140. [DOI: 10.1016/j.seizure.2018.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 12/28/2022] Open
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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
|
6
|
Dalziel SR, Furyk J, Bonisch M, Oakley E, Borland M, Neutze J, Donath S, Sharpe C, Harvey S, Davidson A, Craig S, Phillips N, George S, Rao A, Cheng N, Zhang M, Sinn K, Kochar A, Brabyn C, Babl FE. A multicentre randomised controlled trial of levetiracetam versus phenytoin for convulsive status epilepticus in children (protocol): Convulsive Status Epilepticus Paediatric Trial (ConSEPT) - a PREDICT study. BMC Pediatr 2017. [PMID: 28641582 PMCID: PMC5480418 DOI: 10.1186/s12887-017-0887-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines, with current treatment protocols based solely on non-experimental evidence and expert opinion. The current standard of care, phenytoin, is only 60% effective, and associated with considerable adverse effects. A newer anti-convulsant, levetiracetam, can be given faster, is potentially more efficacious, with a more tolerable side effect profile. The primary aim of the study presented in this protocol is to determine whether intravenous (IV) levetiracetam or IV phenytoin is the better second line treatment for the emergency management of CSE in children. Methods/Design 200 children aged between 3 months and 16 years presenting to 13 emergency departments in Australia and New Zealand with CSE, that has failed to stop with first line benzodiazepines, will be enrolled into this multicentre open randomised controlled trial. Participants will be randomised to 40 mg/kg IV levetiracetam infusion over 5 min or 20 mg/kg IV phenytoin infusion over 20 min. The primary outcome for the study is clinical cessation of seizure activity five minutes following the completion of the infusion of the study medication. Blinded confirmation of the primary outcome will occur with the primary outcome assessment being video recorded and assessed by a primary outcome assessment team blinded to treatment allocation. Secondary outcomes include: Clinical cessation of seizure activity at two hours; Time to clinical seizure cessation; Need for rapid sequence induction; Intensive care unit (ICU) admission; Serious adverse events; Length of Hospital/ICU stay; Health care costs; Seizure status/death at one-month post discharge. Discussion This paper presents the background, rationale, and design for a randomised controlled trial comparing levetiracetam to phenytoin in children presenting with CSE in whom benzodiazepines have failed. This study will provide the first high quality evidence for management of paediatric CSE post first-line benzodiazepines. Trial registration Prospectively registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR): ACTRN12615000129583 (11/2/2015). UTN U1111–1144-5272. ConSEPT protocol version 4 (12/12/2014).
Collapse
Affiliation(s)
- Stuart R Dalziel
- Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand. .,Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Jeremy Furyk
- The Townsville Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Megan Bonisch
- Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand
| | - Ed Oakley
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | | | | | - Susan Donath
- Murdoch Childrens Research Institute, Victoria, Australia
| | - Cynthia Sharpe
- Starship Children's Hospital, Private Bag 92024, Auckland, 1142, New Zealand
| | - Simon Harvey
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | | | - Natalie Phillips
- Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Shane George
- Gold Coast University Hospital, Southport, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia.,Bond University, Gold Coast, Queensland, Australia
| | - Arjun Rao
- Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Nicholas Cheng
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Michael Zhang
- John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Kam Sinn
- Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Amit Kochar
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | - Franz E Babl
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | | |
Collapse
|
7
|
Smith DM, McGinnis EL, Walleigh DJ, Abend NS. Management of Status Epilepticus in Children. J Clin Med 2016; 5:jcm5040047. [PMID: 27089373 PMCID: PMC4850470 DOI: 10.3390/jcm5040047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/02/2016] [Accepted: 04/07/2016] [Indexed: 01/04/2023] Open
Abstract
Status epilepticus is a common pediatric neurological emergency. Management includes prompt administration of appropriately selected anti-seizure medications, identification and treatment of seizure precipitant(s), as well as identification and management of associated systemic complications. This review discusses the definitions, classification, epidemiology and management of status epilepticus and refractory status epilepticus in children.
Collapse
Affiliation(s)
- Douglas M Smith
- Departments of Neurology and Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Emily L McGinnis
- Departments of Neurology and Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Diana J Walleigh
- Departments of Neurology and Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Nicholas S Abend
- Departments of Neurology and Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| |
Collapse
|
8
|
Connolly AM, Beavis E, Mugica-Cox B, Bye AME, Lawson JA. Exploring carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures (2008-2012). J Paediatr Child Health 2015; 51:704-7. [PMID: 25594133 DOI: 10.1111/jpc.12811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/28/2022]
Abstract
AIM This study aims to explore carer perceptions of training in out-of-hospital use of buccal midazolam for emergency management of seizures. METHODS A random sample of 100 families (from n = 198) who underwent training at the Sydney Children's Hospitals Network, Randwick campus (2008-2012) were invited to participate in a telephone questionnaire. RESULTS Sixty-three carers participated. Thirty-three children were female, median age at training was 4 years and seizure onset 2.75 years. Seizures were generalised in 26 children and focal in 37. Common reasons for prescription included history of prolonged seizures (38%), recent diagnosis of epilepsy (33%) and overseas travel (11%). Ninety-eight per cent of carers reported that training instructions were clear, and 94% reported the risks of using benzodiazepines were satisfactorily explained. Ninety per cent felt confident to administer the drug following training and 62% completed first aid training as recommended. Suggestions for improvement included follow-up/review and additional demonstration/practice. Twenty-one carers (33%) reported giving buccal midazolam a median five times, 67% reported it was effective in terminating the seizure and 71% called an ambulance as instructed. Problems reported in administration included excessive secretions and difficulties drawing up the solution. One child experienced breathing difficulties requiring oxygen by the paramedics. Four children were admitted to children's intensive care unit with status epilepticus requiring intubation. CONCLUSIONS Training for out-of-hospital use of buccal midazolam was considered valuable by carers. Only a third of the sample subsequently used midazolam. Half of these carers reported problems in administration and one reported respiratory difficulty. These results highlight the importance of drug safety and efficacious training programmes.
Collapse
Affiliation(s)
- Anne M Connolly
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Erin Beavis
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Beatrice Mugica-Cox
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Ann M E Bye
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - John A Lawson
- Department of Neurology, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Abstract
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 antiseizure medications. If seizures persist, then refractory SE is diagnosed and management options include additional antiseizure medications or infusions of midazolam or pentobarbital. This article reviews the management of pediatric SE and refractory SE.
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW This review discusses the management of status epilepticus in children, including both anticonvulsant medications and overall management approaches. RECENT FINDINGS Rapid management of status epilepticus is associated with a greater likelihood of seizure termination and better outcomes, yet data indicate that there are often management delays. This review discusses an overall management approach aiming to simultaneously identify and manage underlying precipitant causes, administer anticonvulsants in rapid succession until seizures have terminated, and identify and manage systemic complications. An example management pathway is provided. SUMMARY Status epilepticus is a common neurologic emergency in children and requires rapid intervention. Having a predetermined status epilepticus management pathway can expedite management.
Collapse
|
12
|
Babl FE, Krieser D, Oakley E, Dalziel S. A platform for paediatric acute care research. Emerg Med Australas 2014; 26:419-22. [DOI: 10.1111/1742-6723.12286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Franz E Babl
- Department of Emergency Medicine; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; Faculty of Medicine, Dentistry, and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - David Krieser
- Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; Faculty of Medicine, Dentistry, and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
- Paediatric Emergency Department; Sunshine Hospital; Melbourne Victoria Australia
| | - Ed Oakley
- Department of Emergency Medicine; Royal Children's Hospital; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; Faculty of Medicine, Dentistry, and Health Sciences; The University of Melbourne; Melbourne Victoria Australia
| | - Stuart Dalziel
- Children's Emergency Department; Starship Children's Hospital; Auckland New Zealand
- Liggins Institute; University of Auckland; Auckland New Zealand
| |
Collapse
|
13
|
Portela JL, Garcia PCR, Piva JP, Barcelos A, Bruno F, Branco R, Tasker RC. Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: a randomized clinical trial. Med Intensiva 2014; 39:160-6. [PMID: 24928286 DOI: 10.1016/j.medin.2014.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
AIM To compare the therapeutic efficacy of intramuscular midazolam (MDZ-IM) with that of intravenous diazepam (DZP-IV) for seizures in children. DESIGN Randomized clinical trial. SETTING Pediatric emergency department. PATIENTS Children aged 2 months to 14 years admitted to the study facility with seizures. INTERVENTION Patients were randomized to receive DZP-IV or MDZ-IM. MAIN MEASUREMENTS Groups were compared with respect to time to treatment start (min), time from drug administration to seizure cessation (min), time to seizure cessation (min), and rate of treatment failure. Treatment was considered successful when seizure cessation was achieved within 5min of drug administration. RESULTS Overall, 32 children (16 per group) completed the study. Intravenous access could not be obtained within 5min in four patients (25%) in the DZP-IV group. Time from admission to active treatment and time to seizure cessation was shorter in the MDZ-IM group (2.8 versus 7.4min; p<0.001 and 7.3 versus 10.6min; p=0.006, respectively). In two children per group (12.5%), seizures continued after 10min of treatment, and additional medications were required. There were no between-group differences in physiological parameters or adverse events (p=0.171); one child (6.3%) developed hypotension in the MDZ-IM group and five (31%) developed hyperactivity or vomiting in the DZP-IV group. CONCLUSION Given its efficacy and ease and speed of administration, intramuscular midazolam is an excellent option for treatment of childhood seizures, enabling earlier treatment and shortening overall seizure duration. There were no differences in complications when applying MDZ-IM or DZP-IV.
Collapse
Affiliation(s)
- J L Portela
- Pediatric Emergency Department, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria (UFSM), Av. Roraima, Prédio 22, Campus, Bairro Camobi, Zip Code: 97105 900, Santa Maria, RS, Brazil; School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - P C R Garcia
- Department of Pediatrics, School of Medicine, PUCRS, Brazil; Hospital São Lucas, PUCRS, Porto Alegre, RS, Brazil.
| | - J P Piva
- Department of Pediatrics, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - A Barcelos
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Pediatric Emergency Department, Hospital Universitário de Santa Maria, UFSM, Brazil
| | - F Bruno
- Department of Pediatrics, School of Medicine, PUCRS, Brazil; Hospital São Lucas, PUCRS, Porto Alegre, RS, Brazil
| | - R Branco
- Pediatric Intensive Care Locum Consultant, Addenbrooke's Hospital, Cambridge, UK
| | - R C Tasker
- Pediatric NeuroCritical Care Program, CHMC, Boston, USA; Harvard Medical School, USA
| |
Collapse
|
14
|
Abstract
Status epilepticus (SE) remains a life-threatening condition that afflicts both adults and children, and may occur at onset of epilepsy, especially in children. Febrile SE is the most common cause in children, while other symptomatic causes are less frequent compared to adults. The aetiological workup that must be undertaken in all cases includes neuroimaging and electroencephalography. The various electroencephalographic patterns seen in patients with SE along with the out-of-hospital treatment for SE in children and treatment strategies in cases that are refractory to first-line medical treatments are discussed. Medically induced coma may be necessary in refractory cases, although the optimal agents to use and degree of electroencephalographic suppression in children remain unclear. Neurosurgery is not a well-known treatment option that could be considered for refractory cases. Although the prognosis has probably improved over the years, it remains a potential life-threatening emergency.
Collapse
Affiliation(s)
- Yu-Tze Ng
- Division of Pediatric Neurology, University of Oklahoma Medical Center, Oklahoma City, Oklahoma 73104, United States.
| | | |
Collapse
|
15
|
Seshia SS, Bingham WT, Kirkham FJ, Sadanand V. Nontraumatic Coma in Children and Adolescents: Diagnosis and Management. Neurol Clin 2011; 29:1007-43. [DOI: 10.1016/j.ncl.2011.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
16
|
Abend NS, Gutierrez-Colina AM, Dlugos DJ. Medical treatment of pediatric status epilepticus. Semin Pediatr Neurol 2010; 17:169-75. [PMID: 20727486 DOI: 10.1016/j.spen.2010.06.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Status epilepticus (SE) is a common pediatric neurologic emergency that refers to a prolonged seizure or recurrent seizures without a return to baseline mental status between seizures. Appropriate treatment strategies are necessary to prevent prolonged SE and its associated morbidity and mortality. This review discusses the importance of a rapid and organized management approach, reviews data related to commonly utilized medications including benzodiazepines, phenytoin, phenobarbital, valproate sodium, and levetiracetam, and then provides a sample SE management algorithm.
Collapse
Affiliation(s)
- Nicholas S Abend
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | | | | |
Collapse
|