Factors contributing to the duration of a single convulsive seizure > 5 minutes were analyzed in 157 children. The medically treated episodes were compared with seizure episodes resolving without treatment (n = 27). Major differences were in age (p = 0.016) and etiology (p = 0.003), and the association between treatment delay and response became significant after 30 minutes when this was analyzed as a single variable (p = 0.003) in Cox regression analysis.

This retrospective study includes 65 children treated for status epilepticus at Tampere University Hospital in Finland. Aetiology of the condition, effectiveness of the treatment protocol, including short barbiturate anaesthesia to prevent prolonged status epilepticus episodes, and neurological outcome were evaluated. Symptomatic aetiology was present in 40% of status epilepticus episodes, and 37% of episodes were induced by fever. Neurological sequelae secondary to status epilepticus were identified in 15% of the cases and subsequent epilepsy in 23% during the mean follow‐up time of 3.6 years. There were no status epilepticus‐related deaths. The cut‐off point of status epilepticus duration for significant risk for permanent neurological sequelae was 2 hours. Our treatment protocol, including short barbiturate anaesthesia in refractory cases, was able to abort status epilepticus in less than 2 hours in 75% of cases. We conclude that early and prompt use of barbiturate anaesthesia should be encouraged, and may explain our low morbidity figures.

Frequent epileptic seizures in children are often related to delayed psychomotor development, and status epilepticus is always a neurological emergency. In both situations barbiturate anaesthesia has been used for status epilepticus since the 1960s, and for intractable seizures in children since the 1980s. However, the clinical results on the effectiveness of barbiturate anaesthesia in children with chronic epileptic disorders remain contradictory. Between 1986 and 1991 in Tampere University Hospital in Finland long barbiturate anaesthesia was introduced--using thiopentone sodium--to eight children with very severe epilepsy. Children were 10 months to 7 years 11 months of age and the mean time from the onset of seizures to the introduction of BA was 2 years 8 months. Effects upon seizure frequency, antiepileptic medication and/or psychomotor development were clearly positive in three patients, slightly positive in one patient and in four patients there was no effect. Good effect seemed to be associated with an anaesthesia which is deep and long enough to produce loss of consciousness and spontaneous reactions, and an electroencephalographic pattern of burst-suppression. Positive results were also more often achieved when the treatment lag was less than 12 months. Physical and neurophysiological properties of barbiturates make their effectiveness as anticonvulsants understandable, but there is only little evidence to explain the mechanism of this action.

No abstract