Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children

Abstract

Background Febrile status epilepticus is the most common form of status epilepticus in children. No previous reports compare the effectiveness of treatment strategies using fosphenytoin (fPHT) or phenobarbital (PB) and those using anesthetics as second-line anti-seizure medication for benzodiazepine-resistant convulsive status epilepticus (CSE). We aimed to examine the outcomes of various treatment strategies for febrile convulsive status epilepticus (FCSE) in a real-world setting while comparing the effects of different treatment protocols and their presence or absence. Methods This was a single-center historical cohort study that was divided into three periods. Patients who presented with febrile convulsive status epilepticus for ≥60 min even after the administration of at least one anticonvulsant were included. During period I (October 2002–December 2006), treatment was performed at the discretion of the attending physician, without a protocol. During period II (January 2007–February 2013), barbiturate coma therapy (BCT) was indicated for FCSE resistant to benzodiazepines. During period III (March 2013–April 2016), BCT was indicated for FCSE resistant to fPHT or PB. Results The rate of electroencephalogram monitoring was lower in period I than period II+III (11.5% vs. 85.7%, p<0.01). Midazolam was administered by continuous infusion more often in period I than period II+III (84.6% vs. 25.0%, p<0.01), whereas fPHT was administered less often in period I than period II+III (0% vs. 27.4%, p<0.01). The rate of poor outcome, which was determined using the Pediatric Cerebral Performance Category scale, was higher in period I than period II+III (23.1% vs. 7.1%, p=0.03). The rate of poor outcome did not differ between periods II and III (4.2% vs. 11.1%, p=0.40). Conclusions While the presence of a treatment protocol for FCSE in children may improve outcomes, a treatment protocol using fPHT or PB may not be associated with better outcomes.

Epileptic Status in a PEDiatric cohort (ESPED) requiring intensive care treatment: A multicenter, national, two‐year prospective surveillance study

“…In addition, 39% of previously normally developing patients will present with new deficits during follow‐up, with longer electroclinical RSE duration being a predictor 32 . Importantly, some data suggest that using a standardized treatment protocol may be associated with improved outcomes 33 …”

Timing of therapeutic interventions against infection-triggered encephalopathy syndrome: a scoping review of the pediatric literature

“…They found that the time from onset of status epilepticus to TTM induction correlated with the outcome at T1, whereas the time from onset of late seizures at T4 to TTM initiation did not correlate with the outcome. Tokumoto et al (2022) reported the hourly protocol orient management including TTM aiming to start treatment around 6 h after onset (T1) for febrile convulsive status epilepticus reduced neurological sequelae and cases finally diagnosed as AE even though the ratio who underwent TTM were not different. Hoshide et al (2020) conducted a historical cohort study involving the use of therapeutic hypothermia in children with identified late seizures and a diagnosis of AESD confirmed at T4.…”

“…Furthermore, the clinical course and final diagnosis can be modified by acute treatment. For example, early intervention for children with febrile status epilepticus may prevent progression to AE ( Tokumoto et al, 2022 ). Notably, interventional studies for AEs vary in terms of the timing of treatment initiation across studies, implying that the purpose of treatment and the implications of treatment efficacy depend not only on the disease condition, but also on the timing of treatment initiation.…”