Management of Status Epilepticus in Children

Smith, Douglas M.; McGinnis, Emily; Walleigh, Diana J.; Abend, Nicholas S.

doi:10.3390/jcm5040047

Cited by 54 publications

(64 citation statements)

References 155 publications

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Section: Introductionmentioning

confidence: 99%

“…Although SE can occur in patients of any age, SE incidence rates are higher in the pediatric population than in the adult population . Adult and pediatric SE have different disease etiologies, with febrile SE and central nervous system infections being among the most common pediatric causes . The infant and childhood population appears particularly vulnerable to long‐lasting SE‐induced damage, as the developing brain is most sensitive to early insult, and repair mechanisms can create aberrant connections that persist into adulthood .…”

Section: Introductionmentioning

confidence: 99%

“…Adult and pediatric SE have different disease etiologies, with febrile SE and central nervous system infections being among the most common pediatric causes . The infant and childhood population appears particularly vulnerable to long‐lasting SE‐induced damage, as the developing brain is most sensitive to early insult, and repair mechanisms can create aberrant connections that persist into adulthood . Despite an increased incidence rate in children, reduced mortality rates have been observed compared to adult populations .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

et al. 2019

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Summary Objective Status epilepticus (SE) is an important medical emergency condition with particularly unfavorable outcome in refractory and superrefractory SE (SRSE). The economic impact of SE and especially of SRSE in the pediatric population remains unclear. We aimed to determine the burden of illness of SE in a pediatric patient population. Methods Insurance records for patients aged 0‐18 years admitted between 2008 and 2015 were selected from a nationwide insurance research database utilizing International Classification of Diseases and Related Health Problems, 10th Revision (ICD‐10) codes for SE (G41), epilepsy (G40), or febrile convulsions (R56). Patients were further classified based on admission to the intensive care unit and use of mechanical ventilation. Results The algorithm identified 11 693 seizure‐related admissions and classified 4% as SE. Of these cases, 282 (60.4%) were classified by the algorithm as nonrefractory SE (NRSE), 125 (26.8%) as refractory SE (RSE), and 60 (12.8%) as SRSE. The crude SE incidence was 17.6/100 000, with NRSE being 11.4/100 000, RSE 3.9/100 000, and SRSE 2.3/100 000. SRSE incidence peaked in the 0‐ to 1‐year‐old age subgroup accounting for 48.3% of all pediatric SRSE admissions. The median length of stay (LOS) for all SE cases was 7 days, with median 44.5 days in SRSE, 5 days in NRSE, and 12 days in RSE. Mean admission costs for total SE were €15 880, with a mean expense for SRSE of €75 358, for NRSE of €4119, and for RSE of €13 864. The mean LOS for non‐SE epilepsy admissions was 3 days, with mean costs of €2697 for epilepsy and €1614 for febrile convulsion admissions. There were no deaths in non‐SE and NRSE admissions, whereas the overall mortality for SE was 3%, with 5.6% in RSE and 11.7% in SRSE. Significance Although cases classified as SE represented 4% of the seizure‐associated admissions, they accounted for 22% of the overall costs. These costs were disproportionately represented by SRSE cases, which accounted for 62% of all SE‐associated costs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

et al. 2019

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“…Similar finding was observed in a study done by Smith DM who has stated that the incidence of status epilepticus is relatively low in children above 5 years of age. 4 Raspall M et al also has shown in his studythat the incidence of convulsive status epilepticus is highest among children less than 5 years. 5 The incidence is more common in male children 33(63%).Similar male preponderance is seen in a study done by Besli and Saltik.…”

Section: Discussionmentioning

confidence: 99%

Convulsive status epilepticus in children

Jagannathan¹,

Palanivelu²

2017

Int J Contemp Pediatr

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Background: Present study was undertaken to study the clinical profile, immediate outcome and possible risk factors for mortality in children with convulsive status epilepticus, admitted in pediatric intensive care unit in a tertiary care centre.Methods: This retrospective descriptive study included children between 1 month and 12 years of age admitted in pediatric intensive care unit with convulsive status epilepticus from April 2016 to March 2017. They were evaluated for their clinical presentation, laboratory parameters and immediate outcome. Data were gathered on 52 patients with convulsive status epilepticus. Factors were analysed using univariate and multivariate analyses.Results: Among the 52 patients, the observations made were, common age group1-5years (51%), males (63%), wih fever (62%), idiopathic seizures (41.5%), febrile status epilepticus (22.7%) abnormal eeg (9.4%), leuocytosis (54.7%), csf abnormalities (33%), prolonged seizures (33%), need for intubation (31%), shock (29%), mortality (9.4%).Conclusions: Clinical profile of children with convulsive status epilepticus is described. Presence of shock, need for intubation and prolonged seizures are significantly associated with mortality.

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“…Since this data analysis is based on current clinical practice, we considered this limitation representative of ‘real world’ data. We included a population of broad age distribution, as recommendations on emergent use of PHT/FOS are similar among different age groups 21 . Furthermore, protein binding and oxidative metabolism of phenytoin is consistent between acutely sick pediatric and adult populations 22 .…”

Section: Limitationsmentioning

confidence: 99%

Evaluation of phenytoin serum levels following a loading dose in the acute hospital setting

Selioutski

Grzesik

Vasilyeva

et al. 2017

Seizure

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Purpose Due to the complex pharmacokinetic profiles of phenytoin (PHT) and fosphenytoin (FOS), achieving sustained, targeted serum PHT levels in the first day of use is challenging. Methods A population based approach was used to analyze total serum PHT (tPHT) level within 2–24 hours of PHT/FOS loading with or without supplementary maintenance or additional loading doses among PHT-naïve patients in the acute hospital setting. Adequate tPHT serum level was defined as ≥ 20 μg/mL. Results Among 494 patients with 545 tPHT serum levels obtained in the first 2–24 hours after the loading dose (LD), tPHT serum levels of either < or ≥ 20 μg/mL were observed along wide and overlapping cumulative dose ranges. Among those receiving 15–20 mg/kg and 20–55 mg/kg weight-based loading dose, 63 % and 51 % respectively did not attain tPHT serum level of ≥ 20 μg/mL even within the first 6 hours of treatment. For the 393 available concomitant free and total serum PHT levels, correlation was weak, r=0.36. Conclusion Close laboratory surveillance and PHT/FOS dose adjustments are recommended to ensure adequate and sustained tPHT serum levels early in treatment. Free serum PHT level is the preferred method of drug monitoring.

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Management of Status Epilepticus in Children

Cited by 54 publications

References 155 publications

Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

Convulsive status epilepticus in children

Evaluation of phenytoin serum levels following a loading dose in the acute hospital setting

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