Management protocols for status epilepticus in the pediatric emergency room: systematic review article

Abstract

All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery.

The effect of early midazolam infusion on the duration of pediatric status epilepticus patients

“…If a patient with existing epilepsy has SE, the previous AED should be given first. However, the other patients received phenytoin as the most preferred second-line therapy because of its longacting effects according to the literature [9], and there is no clear evidence that any one of these drugs is better than the others.…”

“…In the literature, there are many national and regional guidelines for SE [9]. Although after initial stabilization, the first phase of therapy is the administration of BDZ in all guidelines, the choice of drugs for a second or third phase of therapies and the timing of the general anesthetic drugs for RSE are challenging in pediatric patients.…”

Hospital Emergency Treatment of Convulsive Status Epilepticus: Comparison of Pathways From Ten Pediatric Research Centers

“…Nevertheless, we acknowledge prior US guidelines that have contributed to the diagnosis and treatment of status epilepticus in the United States. 6,13…”

“…21 Hence, their guideline uses three stages: (1) immediate control therapy with administration of initial therapy (BZD) and supportive treatment; (2) urgent control therapy with the administration of an AED; and (3) refractory status epilepticus management, defined as status epilepticus that does not respond to initial BZD followed by another AED, with administration of continuous infusion. 6 The Neurocritical Care Society guideline suggests timings for each of these interventions but the approach is not comparable to the AES guideline 13 or the pSERG hospitals status epilepticus pathways. Therefore we have not included this approach in our comparative analysis.…”

“…[6][7][8] Nevertheless, adherence to these guidelines remains a challenge, because of the context of treatment, case-by-case clinical reasoning and the availability of medications. Different countries report variations in the time to treatment, choice of medication, and doses administered [9][10][11][12][13][14] that may lead to differences in clinical outcomes.…”