Inappropriate emergency management of status epilepticus in children contributes to need for intensive care

Chin, Richard; Verhulst, L; Neville, Brian; Peters, Mark; Scott, Rod C.

doi:10.1136/jnnp.2003.032797

Cited by 129 publications

(137 citation statements)

References 17 publications

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“…Contrary to the Advanced Pediatric Life Support guidelines many children admitted for SE receive over two doses, or inadequate doses of benzodiazepine [10].…”

Section: Control Of Seizuresmentioning

confidence: 95%

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Status Epilepticus in Children

Behera

Rana

Kanitkar

et al. 2005

Medical Journal Armed Forces India

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Status epilepticus (SE) is a life-threatening emergency that requires prompt treatment, including basic neuroresuscitation principles (the ABCs), antiepileptic drugs to stop the seizure and identification of etiology. It results from an inability to normally abort an isolated seizure either due to ineffective inhibition, or due to abnormally persistent excessive excitation. Symptomatic SE is more common in younger children and the likely etiology depends on the age of the child. Treating the precipitating cause may prevent ongoing neurologic injury and facilitates seizure control. Benzodiapenes, phenytoin and phenobarbital form the mainstay of treatment. A systematic treatment regimen, planned in advance, is needed, including one for refractory status epilepticus (RSE

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“…Contrary to the Advanced Pediatric Life Support guidelines many children admitted for SE receive over two doses, or inadequate doses of benzodiazepine [10].…”

Section: Control Of Seizuresmentioning

confidence: 95%

“…Whereas febrile SE is the most common cause in children less than five years of age, trauma and infections are important in older children [1]. Severe hypoxic encephalopathy and inborn error of metabolism may present with SE in the newborn [9,10].…”

Section: Incidencementioning

confidence: 99%

Status Epilepticus in Children

Behera

Rana

Kanitkar

et al. 2005

Medical Journal Armed Forces India

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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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“…Although useless and dangerous escalation may then become tempting, 29,30 doses should be reduced to prevent adverse effects. The issue is then the time lag to efficacy (ketosis) and tolerability.…”

Section: Discussionmentioning

confidence: 99%

The ketogenic diet improves recently worsened focal epilepsy

Villeneuve

Pinton

Bahi‐Buisson

et al. 2009

Develop Med Child Neuro

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Aim We observed a dramatic response to the ketogenic diet in several patients with highly refractory epilepsy whose seizure frequency had recently worsened. This study aimed to identify whether this characteristic was a useful indication for the ketogenic diet. Method From the 70 patients who received the ketogenic diet during a 3‐year period at our institution, we retrospectively selected patients with focal epilepsy. There were 22 children, 13 females and nine males, aged from 5 months to 18 years 6 months (mean 6y 9mo, SD 5y 11mo). Fifteen had symptomatic and seven had cryptogenic focal epilepsy. Seizure frequency 1 week before initiating the ketogenic diet was compared with that at 1 month and at the last visit on the diet. Results Eleven patients were responders (defined as reduction of seizures by more than 50%) at 1 month. Responders were higher (p=0.046) in the group with a recent worsening of seizures than in those with stable seizure frequency. Seven patients were still seizure‐free at 6 months on the diet. Tolerability was excellent in 10 patients. Five patients stopped the diet because of early side effects. Interpretation The ketogenic diet may be a valuable therapeutic option for children with pharmacoresistant focal epilepsy, particularly those with a recent deterioration of seizure control and neurological status. Because of its rapid effect, the ketogenic diet may be a useful support to intravenous emergency drugs in such a situation.

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Inappropriate emergency management of status epilepticus in children contributes to need for intensive care

Abstract: As the risk of respiratory depression is greater with more than two doses of benzodiazepines, clinicians should not disregard prehospital treatment of SE. As pre-PIC treatment of SE is inadequate in many cases, appropriate audit and modifications of standard guidelines are required.

Cited by 129 publications

References 17 publications

Status Epilepticus in Children

Status Epilepticus in Children

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

The ketogenic diet improves recently worsened focal epilepsy

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