Efficacy, Tolerability and Serum Phenytoin Levels after Intravenous Fosphenytoin Loading Dose in Children with Status Epilepticus

Srivastava, Kavita; Bhartiya, Shirish; Gavli, Vrushabh; Patil, Rahul; Rajadhyaksha, Surekha

doi:10.1007/s13312-020-1754-5

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…Similar to phenytoin, the maximum recommended loading dose of fosphenytoin is 50 mg/min [67]. For pediatric patients, the recommended administration rate is 1-2 mg/kg/minute [75]; a loading dose of 20 mg/kg has shown efficacy and a good safety profile in a majority of children with SE [76]. In emergency situations, the rapid administration of fosphenytoin is a recommended option [67].…”

Section: Fosphenytoinmentioning

confidence: 99%

Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management

Kirmani¹,

Au²,

Ayari³

et al. 2021

Aging and disease

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Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency with high morbidity and mortality. It is defined as "status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthesia, including those cases in which SE recurs on the reduction or withdrawal of anesthesia." This condition is resistant to normal protocols used in the treatment of status epilepticus and exposes patients to increased risks of neuronal death, neuronal injury, and disruption of neuronal networks if not treated in a timely manner. It is mainly seen in patients with severe acute onset brain injury or presentation of new-onset refractory status epilepticus (NORSE). The mortality, neurological deficits, and functional impairments are significant depending on the duration of status epilepticus and the resultant brain damage. Research is underway to find the cure for this devastating neurological condition. In this review, we will discuss the wide range of therapies used in the management of SRSE, provide suggestions regarding its treatment, and comment on future directions. The therapies evaluated include traditional and alternative anesthetic agents with antiepileptic agents. The other emerging therapies include hypothermia, steroids, immunosuppressive agents, electrical and magnetic stimulation therapies, emergent respective epilepsy surgery, the ketogenic diet, pyridoxine infusion, cerebrospinal fluid drainage, and magnesium infusion. To date, there is a lack of robust published data regarding the safety and effectiveness of various therapies, and there continues to be a need for large randomized multicenter trials comparing newer therapies to treat this refractory condition.

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Section: Fosphenytoinmentioning

confidence: 99%

Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management

Kirmani¹,

Au²,

Ayari³

et al. 2021

Aging and disease

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“…Phenobarbital can cause respiratory depression, hypotension, and bradycardia and should thus be given only in an intensive care setting. When phenobarbital and fosphenytoin are used sequentially, fosphenytoin has been suggested to precede phenobarbital, especially when benzodiazepines have already been used, on account of its better safety profile and the lower likelihood of cardiorespiratory depression ( 62 , 63 ). There is insufficient data about the comparative efficacy of phenytoin and fosphenytoin; however, fosphenytoin is better tolerated compared with phenytoin with respect to cardiac arrhythmias, blood pressure imbalance, and local skin reactions ( 16 ).…”

Section: Resultsmentioning

confidence: 99%

Treatment of pediatric convulsive status epilepticus

et al. 2023

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Status epilepticus is one of the most common life-threatening neurological emergencies in childhood with the highest incidence in the first 5 years of life and high mortality and morbidity rates. Although it is known that a delayed treatment and a prolonged seizure can cause permanent brain damage, there is evidence that current treatments may be delayed and the medication doses administered are insufficient. Here, we summarize current knowledge on treatment of convulsive status epilepticus in childhood and propose a treatment algorithm. We performed a structured literature search via PubMed and ClinicalTrails.org and identified 35 prospective and retrospective studies on children <18 years comparing two and more treatment options for status epilepticus. The studies were divided into the commonly used treatment phases. As a first-line treatment, benzodiazepines buccal/rectal/intramuscular/intravenous are recommended. For status epilepticus treated with benzodiazepine refractory, no superiority of fosphenytoin, levetirazetam, or phenobarbital was identified. There is limited data on third-line treatments for refractory status epilepticus lasting >30 min. Our proposed treatment algorithm, especially for children with SE, is for in and out-of-hospital onset aids to promote the establishment and distribution of guidelines to address the treatment delay aggressively and to reduce putative permanent neuronal damage. Further studies are needed to evaluate if these algorithms decrease long-term damage and how to treat refractory status epilepticus lasting >30 min.

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“…Two studies in this issue of Indian Pediatrics address this research need. Srivastava, et al [10] report on the efficacy, serum levels achieved and side-effects after intravenous forphenytoin loading dose, and Vignesh, et al [11] report on a randomized-control trial comparing phenytoin, valproate and levetiracetam in pediatric convulsive status epilepticus. At hospital level, every triage area and emergency should display the desired algorithm of use with doses, route of ASDs and the logical step-wise upgradation of therapy [12].…”

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

Childhood Status Epilepticus: Current Status and Future Directions

Kalra

2020

Indian Pediatr

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Efficacy, Tolerability and Serum Phenytoin Levels after Intravenous Fosphenytoin Loading Dose in Children with Status Epilepticus

Cited by 4 publications

References 16 publications

Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management

Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management

Treatment of pediatric convulsive status epilepticus

Childhood Status Epilepticus: Current Status and Future Directions

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