Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children

Abstract

Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children.

An Italian Survey on the Management of Pediatric Convulsive Status Epilepticus: More Than Just a Pharmacological Choice

“…The survey confirmed that MDZ was the most widely used first-line drug administered intravenously, while rectal DZP was the non-iv BDZ most commonly used by pediatric emergency physicians. These results were consistent with other reports (Nuñez et al 2023;Babl et al 2009;Kaputu-Kalala-Malu et al 2014;Wallace et al 2019) and likely reflected multiple factors, including the evidence showing an overall benefit of BDZ habit, self-confidence in one's personal experience, the age of the patient, and the availability of the drug (Zhao et al 2016;McTague et al 2018). Dosage and number of BDZ doses were critical issues: the American Epilepsy Society recommended administering an adequate, single, full dose of BZD that could be repeated if seizures persisted (Glauser et al 2016).…”

An Italian Survey on the Management of Pediatric Convulsive Status Epilepticus: More Than Just a Pharmacological Choice

“…The survey confirmed that MDZ was the most widely used first-line drug administered intravenously, while rectal DZP was the non-iv BDZ most commonly used by pediatric emergency physicians. These results were consistent with other reports (Nuñez et al 2023;Babl et al 2009;Kaputu-Kalala-Malu et al 2014;Wallace et al 2019) and likely reflected multiple factors, including the evidence showing an overall benefit of BDZ habit, self-confidence in one's personal experience, the age of the patient, and the availability of the drug (Zhao et al 2016;McTague et al 2018). Dosage and number of BDZ doses were critical issues: the American Epilepsy Society recommended administering an adequate, single, full dose of BZD that could be repeated if seizures persisted (Glauser et al 2016).…”

Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

“…Three different ASMs were used to treat the CSE of which BZDs (MDZ and DZP) were significantly more frequently used than PHT as first line agents. This in line with recently published studies, protocols and a Cochrane review [6,15,31]. First line treatment with BZDs seems to resolve CSE in 70.0% of the patients [33].…”

Treatment of pediatric convulsive status epilepticus

“…This result was not statistically significant when studying only the 120 children, and the prolonged time to achieve an IV line for the application of lorazepam needs to be considered. This result is supported by two further meta-analyses including the Cochrane review with similar or better seizure cessation rate of IM midazolam than IV diazepam/lorazepam ( 15 , 23 , 53 – 55 ).…”

“…Another meta-analysis on midazolam, lorazepam, and diazepam for the treatment of SE in children found a superior effect for non-IV midazolam (buccal, IN, or IM) in comparison to non-IV diazepam ( 23 ). In conclusion, buccal midazolam has been reported to be at least as effective in cessation of SE, equally safe, and also more socially acceptable than rectal diazepam ( 10 , 15 , 16 , 25 – 33 ). Buccal midazolam is also the most cost-effective drug in the United States ( 34 ).…”

An Italian Survey on the Management of Pediatric Convulsive Status Epilepticus: More Than Just a Pharmacological Choice

“…The survey confirmed that MDZ was the most widely used first-line drug administered intravenously, while rectal DZP was the non-iv BDZ most commonly used by pediatric emergency physicians. These results were consistent with other reports (Nuñez et al 2023;Babl et al 2009;Kaputu-Kalala-Malu et al 2014;Wallace et al 2019) and likely reflected multiple factors, including the evidence showing an overall benefit of BDZ habit, self-confidence in one's personal experience, the age of the patient, and the availability of the drug (Zhao et al 2016;McTague et al 2018). Dosage and number of BDZ doses were critical issues: the American Epilepsy Society recommended administering an adequate, single, full dose of BZD that could be repeated if seizures persisted (Glauser et al 2016).…”

Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

“…Three different ASMs were used to treat the CSE of which BZDs (MDZ and DZP) were significantly more frequently used than PHT as first line agents. This in line with recently published studies, protocols and a Cochrane review [6,15,31]. First line treatment with BZDs seems to resolve CSE in 70.0% of the patients [33].…”

Treatment of pediatric convulsive status epilepticus

“…This result was not statistically significant when studying only the 120 children, and the prolonged time to achieve an IV line for the application of lorazepam needs to be considered. This result is supported by two further meta-analyses including the Cochrane review with similar or better seizure cessation rate of IM midazolam than IV diazepam/lorazepam ( 15 , 23 , 53 – 55 ).…”

“…Another meta-analysis on midazolam, lorazepam, and diazepam for the treatment of SE in children found a superior effect for non-IV midazolam (buccal, IN, or IM) in comparison to non-IV diazepam ( 23 ). In conclusion, buccal midazolam has been reported to be at least as effective in cessation of SE, equally safe, and also more socially acceptable than rectal diazepam ( 10 , 15 , 16 , 25 – 33 ). Buccal midazolam is also the most cost-effective drug in the United States ( 34 ).…”

An Italian Survey on the Management of Pediatric Convulsive Status Epilepticus: More Than Just a Pharmacological Choice

“…The survey confirmed that MDZ was the most widely used first-line drug administered intravenously, while rectal DZP was the non-iv BDZ most commonly used by pediatric emergency physicians. These results were consistent with other reports (Nuñez et al 2023;Babl et al 2009;Kaputu-Kalala-Malu et al 2014;Wallace et al 2019) and likely reflected multiple factors, including the evidence showing an overall benefit of BDZ habit, self-confidence in one's personal experience, the age of the patient, and the availability of the drug (Zhao et al 2016;McTague et al 2018). Dosage and number of BDZ doses were critical issues: the American Epilepsy Society recommended administering an adequate, single, full dose of BZD that could be repeated if seizures persisted (Glauser et al 2016).…”

Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

“…Three different ASMs were used to treat the CSE of which BZDs (MDZ and DZP) were significantly more frequently used than PHT as first line agents. This in line with recently published studies, protocols and a Cochrane review [6,15,31]. First line treatment with BZDs seems to resolve CSE in 70.0% of the patients [33].…”

Treatment of pediatric convulsive status epilepticus

“…This result was not statistically significant when studying only the 120 children, and the prolonged time to achieve an IV line for the application of lorazepam needs to be considered. This result is supported by two further meta-analyses including the Cochrane review with similar or better seizure cessation rate of IM midazolam than IV diazepam/lorazepam ( 15 , 23 , 53 – 55 ).…”

“…Another meta-analysis on midazolam, lorazepam, and diazepam for the treatment of SE in children found a superior effect for non-IV midazolam (buccal, IN, or IM) in comparison to non-IV diazepam ( 23 ). In conclusion, buccal midazolam has been reported to be at least as effective in cessation of SE, equally safe, and also more socially acceptable than rectal diazepam ( 10 , 15 , 16 , 25 – 33 ). Buccal midazolam is also the most cost-effective drug in the United States ( 34 ).…”