Emergency Management of Pediatric Convulsive Status Epilepticus

Lewena, Stuart; Pennington, Victoria; Acworth, Jason; Thornton, Susan; Ngo, Peter; McIntyre, Shona; Krieser, David; Neutze, Jocelyn; Speldewinde, Deirdre

doi:10.1097/pec.0b013e318196ea6e

Cited by 58 publications

(67 citation statements)

References 25 publications

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“…The assessment of compliance and effectiveness was based on pre-existing and proposed quality assessment indicators for the treatment of pediatric SE that were discussed by experts at a Pediatric Emergency National Advisory Panel held in 2011 (Table 1). [24][25][26][27][28][29][30][31][32] Respiratory depression and hypotension, the two main serious adverse effects following the treatment of SE with benzodiazepines, 20 were used as the two safety outcomes. Respiratory depression was defined as any patient requiring bag/mask ventilation, continuous positive airway pressure (CPAP), or intubation.…”

Section: Methodsmentioning

confidence: 99%

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Tourigny-Ruel

Diksic

Mok

et al. 2014

CJEM

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Objective: 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. RÉ SUMÉObjectif: L'é tude visait à é valuer l'efficacité et l'innocuité d'un simple protocole liné aire, fondé sur le midazolam, pour le traitement d'un é tat de mal é pileptique imminent, chez des enfants â gé s de 18 ans et moins.

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Section: Methodsmentioning

confidence: 99%

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Tourigny-Ruel

Diksic

Mok

et al. 2014

CJEM

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“…26 In a retrospective multicenter study of 542 episodes of convulsive seizures of 10 or more minutes duration in children, the median (p 25 -p 75 ) time from hospital arrival until administration of a non-BZD AED was 24 (15-36) minutes. 27 In a series of 199 children with febrile status epilepticus, the median time from seizure onset to administration of the first AED was 30 minutes. 28 The limited information reported on time of AED administration in adults also points towards significant delays in drug administration.…”

Section: (79)mentioning

confidence: 99%

Time from convulsive status epilepticus onset to anticonvulsant administration in children

et al. 2015

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Objective: To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED).Methods: This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE. Results:We enrolled 81 patients (44 male) with a median age of 3.6 years. The first, second, and third AED doses were administered at a median (p 25 -p 75 ) time of 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes after SE onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2-3) doses of benzodiazepines were administered before switching to nonbenzodiazepine AEDs. The first and second doses of nonbenzodiazepine AEDs were administered at 69 (40-120) minutes and 120 (75-296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5-15) minutes and 16 (10-40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset). Conclusions:The time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the prehospital and in-hospital settings. Status epilepticus (SE) is one of the most common pediatric neurologic emergencies.1 It has a mortality of 0%-3% 2-7 and morbidity that includes cognitive and neurodevelopmental impairments, epilepsy, and recurrent SE.2,8-10 SE is often refractory to the initial antiepileptic drugs (AEDs), 11,12 and refractory SE is associated with poor outcome. 12 Patient age, etiology, and SE duration all affect outcome, 5,9,13 but only SE duration is a potentially modifiable factor by rapid AED treatment. By convention, the treatment of convulsive SE is a sequence of AEDs, typically

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“…17 In a series of 542 patients with convulsive seizures of at least 10 minutes duration, the median (p 25 -p 75 ) time from hospital arrival to administration of a non-BZD AED was 24 (15-36) minutes. 18 The study with the initial 81 patients in the pSERG consortium showed that the time elapsed since SE onset to administration of the first, second, and third AEDs were 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes, respectively. 19 Different endpoints and methodologies complicate direct comparisons, but together, these data suggest that the timeliness of SE treatment needs improvement.…”

mentioning

confidence: 99%

“…Both adults [13][14][15][16][17] and children [17][18][19][20] receive antiepileptic drugs (AEDs) later than recommended by most SE guidelines. [21][22][23] Most episodes of pediatric SE occur in children with no history of seizures.…”

mentioning

confidence: 99%

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

et al. 2017

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Objective: To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).Methods: This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month-21 years of age) with rSE.Results: We enrolled 189 participants (53% male) with a median (25th-75th percentile) age of 4.2 (1.3-9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [ Conclusions: Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication. Neurology ® 2017;88:386-394 GLOSSARY AED 5 antiepileptic drug; BZD 5 benzodiazepine; EMS 5 emergency medical services; ICU 5 intensive care unit; p 25 -p 75 5 25th-75th percentile; pSERG 5 pediatric Status Epilepticus Research Group; rSE 5 refractory status epilepticus; SE 5 status epilepticus.Convulsive status epilepticus (SE) is one of the most common pediatric emergencies. It affects approximately 10-25/100,000 children per year, 1-3 while posing a substantial economic burden to individuals and society. 4,5 Pediatric SE is associated with a short-term mortality of 0%-3% 1,[6][7][8] and long-term mortality of approximately 7%. 9 Survivors often experience both functional and neurobehavioral sequelae 7,8,10 and a reduced quality of life. 11 When SE does not respond to initial medications, it is then considered refractory SE (rSE) and its outcome is markedly worse.

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Emergency Management of Pediatric Convulsive Status Epilepticus

Cited by 58 publications

References 25 publications

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Quality assurance evaluation of a simple linear protocol for the treatment of impending status epilepticus in a pediatric emergency department 2 years postimplementation

Time from convulsive status epilepticus onset to anticonvulsant administration in children

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

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