Midazolam coma for refractory status epilepticus in children

Igartua, Jon; Silver, Peter; Maytal, Joseph; Sagy, Mayer

doi:10.1097/00003246-199909000-00043

Cited by 60 publications

(40 citation statements)

References 23 publications

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“…Numerous clinical studies have shown that midazolam bolus (0.1–0.3 mg/kg) followed by continuous infusion (0.05–2.0 mg/kg/hour) rapidly controls seizures that have not responded to traditional first, second, and even third-line agents [36,37]. Reports of clinically significant hypotension are rare, and sedation is rapidly reversed after infusion is stopped.…”

Section: Treatment Of Refractory Status Epilepticusmentioning

confidence: 99%

Untitled

2002

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Status epilepticus (SE) has an annual incidence exceeding 100,000 cases in the United States alone, of which more than 20% result in death. Thus, increased awareness of presentation, etiologies, and treatment of SE is essential in the practice of critical care medicine. This review discusses current definitions of SE, as well as its clinical presentation and classification. The recent literature on epidemiology is reviewed, including morbidity and mortality data. An overview of the systemic pathophysiologic effects of SE is presented. Finally, significant studies on the treatment of acute SE and refractory SE are reviewed, including the use of anticonvulsants, such as benzodiazepines, and other drugs.

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Section: Treatment Of Refractory Status Epilepticusmentioning

confidence: 99%

Untitled

2002

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“…Table 2 shows the treatments generally accepted as useful, with published case series or case reports. 17,75,78,79,[81][82][83][84][85][86][87][88] There are relative advantages and disadvantages to each of the listed treatments that must be balanced against the gravity of the clinical situation. In nearly all circumstances of refractory status epilepticus, treatment in an intensive care setting is mandatory.…”

Section: Treatment Of Refractory Status Epilepticus In Childrenmentioning

confidence: 99%

Status Epilepticus and Acute Serial Seizures in Children

Mitchell

2002

J Child Neurol

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Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough to produce a fixed and enduring epileptic condition of 30 minutes or longer. Status epilepticus is a life-threatening condition that often occurs in children. The degree of mortality and neurologic morbidity, as well as the risk for recurrence, is highly dependent on the etiology and duration of the seizures. Although much has been written about pediatric status epilepticus, many issues remain unresolved. A better understanding of the different types of seizures and their etiologies may help in the prevention and treatment of status epilepticus. The vast extent of status epilepticus in both children and adults mandates that new options for prevention and treatment be given a close scrutiny and high priority. This article will review the most current information on convulsive and nonconvulsive status epilepticus, including the potential for neurologic damage, changes in magnetic resonance imaging after status epilepticus, risk for recurrence, and current treatment options available for treating status epilepticus in children.

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“…However, previous studies identified an apparent discrepancy: treatment dosing from studies using EEG monitoring to guide therapy [13,19] used considerably higher doses of midazolam when compared with studies using a clinical endpoint to guide treatment (10.7 mcg/kg/min versus 2.8 mcg/kg/min). [12,14–18,20,21] The current pSERG cohort illustrates that an EEG endpoint is currently used in over half of patients and also confirms the utilization of higher midazolam dosing when EEG serves as the endpoint measure (i.e., cessation of EEG seizures 3.8 [2.8 – 5.8] mcg/kg/min or burst suppression 16.7 [9.2 – 25.0] mcg/kg/min).…”

Section: Discussionmentioning

confidence: 99%

Refractory Status Epilepticus in Children: Intention to Treat With Continuous Infusions of Midazolam and Pentobarbital*

Tasker

Goodkin

Fernández

et al. 2016

Pediatric Critical Care Medicine

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Objective To describe pediatric patients with convulsive refractory status epilepticus (RSE) in whom there is intention-to-use an intravenous anesthetic for seizure control. Design Two-year prospective observational study evaluating patients (age range one month to 21 years) with RSE not responding to two antiepileptic drug classes and treated with continuous infusion of anesthetic agent. Setting Nine pediatric hospitals in the United States. Patients In a cohort of 111 patients with RSE (median age 3.7 years, 50% male), 54 (49%) underwent continuous infusion of anesthetic treatment. Main Results The median (interquartile range, IQR) intensive care unit length-of-stay was 10 (3–20) days. Up to four ‘cycles’ of serial anesthetic therapy were used and seizure termination was achieved in 94% by the second cycle. Seizure duration in controlled patients was 5.9 (1.9–34) hours for the first cycle, and longer when a second cycle was required (30 [4,−120] hours, p=0.048). Midazolam was the most frequent first-line anesthetic agent (78%); pentobarbital was the most frequently used second-line agent after midazolam failure (82%). An electroencephalographic endpoint was used in over half of the patients; higher midazolam dosing was used with a burst suppression endpoint. In midazolam non-responders, transition to a second agent occurred after a median of one day. Most patients (94%) experienced seizure termination with these two therapies. Conclusions Midazolam and pentobarbital remains the mainstay of continuous infusion therapy for RSE in the pediatric patient. The majority of patients experience seizure termination within a median of 30 hours. These data have implications for the design and feasibility of future intervention trials. That is, testing a new anesthetic anticonvulsant after failure of both midazolam and pentobarbital is unlikely to be feasible in a pediatric study, whereas a decision to test an alternative to pentobarbital, after midazolam failure, may be possible in a multicenter multinational study.

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Midazolam coma for refractory status epilepticus in children

Cited by 60 publications

References 23 publications

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Status Epilepticus and Acute Serial Seizures in Children

Refractory Status Epilepticus in Children: Intention to Treat With Continuous Infusions of Midazolam and Pentobarbital*

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