Gaps and opportunities in refractory status epilepticus research in children: A multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG)

Fernández, Iván Sánchez; Abend, Nicholas S.; Agadi, Satish; An, Sookee; Arya, Ravindra; Carpenter, Jessica; Chapman, Kevin; Gaillard, William D.; Glauser, Tracy A.; Goldstein, David B.; Goldstein, Joshua; Goodkin, Howard P.; Hahn, Cecil D.; Heinzen, Erin L.; Mikati, Mohamad A.; Peariso, Katrina; Pestian, John; Ream, Margie A.; Riviello, James J.; Tasker, Robert C.; Williams, Korwyn; Loddenkemper, Tobias

doi:10.1016/j.seizure.2013.10.004

Cited by 87 publications

(81 citation statements)

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“…21 The purpose of this study was to describe the timing and escalation of AED administration during all stages of AED administration in the prehospital and in-hospital settings in patients with refractory convulsive status epilepticus (RCSE).…”

Section: Study Design the Pediatric Status Epilepticus Research Groupmentioning

confidence: 99%

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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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Section: Study Design the Pediatric Status Epilepticus Research Groupmentioning

confidence: 99%

“…Details of the pSERG consortium can be found elsewhere. 21 Statistical analysis. Prehospital AED administration.…”

Section: (79)mentioning

confidence: 99%

Time from convulsive status epilepticus onset to anticonvulsant administration in children

et al. 2015

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“…The pediatric Status Epilepticus Research Group (pSERG) is a network of 11 pediatric hospitals in the United States that prospectively collects data on children with SE with the goal of delineating strategies for improving management and prognosis. 24 Patients. We studied patients with rSE in order to asses all of the steps in the management pathway of SE.…”

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confidence: 99%

“…Details of the pSERG consortium have been published. 24 Statistical analysis. Demographic and clinical characteristics were summarized with descriptive statistics.…”

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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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“…[1][2][3] Current management options for SE and RSE in the pediatric/ neonatal patient population include, but are not limited to: benzodiazepines, barbiturates, phenytoin, levetiracetam, carbamazepine, and lidocaine 4 -all of which have displayed varying efficacy at seizure control in SE and RSE. [4][5][6][7] Lidocaine, a class Ib antiarrhythmic agent, has known sodium channel-based AED properties in both the adult and pediatric populations stemming back to the 1950s. [8][9][10][11] Its potential summative benefit in the presence of other sodium channelmediated AEDs seem to be mediated by its amine chain motif and external sodium channel binding site.…”

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Lidocaine for Status Epilepticus in Pediatrics

Zeiler

Teitelbaum

et al. 2015

Can. J. Neurol. Sci.

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Background: Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in pediatrics for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendations Assessment, Development, and Evaluation methodologies by two independent reviewers. Results: Overall, 20 original studies were identified, with 19 manuscripts and one meeting abstract. Two hundred and thirty-five pediatric patients were treated for 252 episodes of SE/RSE. Patients had varying numbers of antiepileptic drugs (two to eight) on board before lidocaine therapy. During 20 of the 252 (7.9%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied, with some using bolus dosing alone; others used a combination of bolus and infusion therapy. Overall, 60.0% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 57.6% and 12.3%, respectively. Patient outcomes were sparingly reported. Conclusions: There currently exists Oxford level 2b, Grading of Recommendations Assessment Developement, and Evaluation C evidence to support the consideration of lidocaine for SE and RSE in the pediatric population. Further prospective studies of lidocaine administration in this setting are warranted.RÉSUMÉ: Traitement de l'état de mal épileptique par la lidocaïne en pédiatrie. Contexte : Nous avons effectué une revue systématique de la littérature à propos de l'utilisation de la lidocaïne par voie intraveineuse chez des enfants en état de mal épileptique (ÉMÉ) ou d'ÉMÉ résistant au traitement (ÉMÉR) afin de déterminer son impact sur le contrôle de l'ÉMÉ. Méthode : Nous avons recherché tous les articles sur ce sujet indexés dans MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (du début jusqu' à novembre 2014) ainsi que la documentation parallèle. Deux réviseurs indépendants ont utilisé l'Oxford and Grading of Recommendations Assessment, Development and Evaluation pour évaluer la qualité des études. Résultats : En tout, 20 études originales ont été identifiées, dont 19 manuscrits et un résumé. Deux cent trente-cinq patients d'âge pédiatrique ont ainsi été traités au cours de 252 épisodes d'ÉMÉ/ÉMÉR. Les patients recevaient plusieurs médicaments antiépileptiques (de 2 à 8) avant le traitement par la lidocaïne. Au cours de 20 des 252 épisodes d'ÉMÉ/ÉMÉR (7,9%), le patient recevait de la phénytoïne. La dose de lidocaïne était variable : certains ont reçu seulement un bolus alors que d'autres ont reçu la lidocaïne en bolus et en perfusion. En tout, 60% des crises ont répondu à la lidocaïne avec arrêt complet de la crise chez 57,6% des...

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Gaps and opportunities in refractory status epilepticus research in children: A multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG)

Cited by 87 publications

References 109 publications

Time from convulsive status epilepticus onset to anticonvulsant administration in children

Time from convulsive status epilepticus onset to anticonvulsant administration in children

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

Lidocaine for Status Epilepticus in Pediatrics

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