Status Epilepticus in Childhood

Ng, Yu-Tze; Maganti, Rama

doi:10.1002/9781119998600.ch20

Cited by 2 publications

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“…Insiden yang lebih tinggi telah dilaporkan pada anak berusia kurang dari 1 tahun, yaitu berkisar 135,2-156 per 100.000 anak/tahun. 3,9 Kejang dikatakan lebih sering terjadi pada anak usia 17-34 bulan. 10 Pada penelitian ini, usia rata-rata pasien status epileptikus adalah 20 bulan (1 tahun 8 bulan) sesuai dengan puncak terjadinya kejang pada anak.…”

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Hubungan Kadar Il-8 Dan Il-4 Pada Anak Dengan Status Epileptikus

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Status epileptikus merupakan suatu kegawatan di bidang neurologi yang memerlukan diagnosis dan terapi yang sesuai. Ketidakseimbangan sitokin proinflamasi dan antiinflamasi bisa menyebabkan kejang yang berlangsung lama. Sitokin proinflamasi dapat mengaktivasi kaskade signaling dan merusak sawar darah-otak yang mengawali mekanisme terjadinya kejang. Penelitian ini ingin mengetahui perbedaan kadar IL-8 dan IL-4 pada anak status epileptikus, kejang tanpa status epileptikus, dan demam tanpa kejang sehingga bisa dijadikan prediktor kejadian status epileptikus. Desain penelitian adalah cross sectional dengan 30 sampel yang terdiri dari 10 anak status epileptikus, 10 anak kejang tanpa status epileptikus, dan 10 anak demam tanpa kejang. Pengukuran IL-8 dan IL-4 menggunakan metode ELISA. Analisis data menggunakan uji one way ANOVA dan korelasi Spearman dengan menggunakan SPSS-23. Didapatkan kadar IL-8 (p = 0,000) berbeda signifikan dan kadar IL-4 tidak berbeda signifikan (p = 0,818) pada status epileptikus, kejang tanpa status epileptikus dan demam tanpa kejang. Namun, rasio IL-4/1L-8 menunjukkan perbedaan yang signifikan (p = 0,000) di antara kelompok. Dapat disimpulkan ada hubungan antara kadar IL-8, rasio IL-4/IL-8 dengan status epileptikus, namun tidak ada hubungan yang signifikan pada kadar IL-4. AbstractStatus epilepticus is a neurological emergency which requires prompt diagnosis and treatment. Imbalance between proinflammatory and antiinflammatory cytokines can cause prolonged seizure. Proinflammatory cytokines may activate signaling cascade and disrupts blood brain barrier which initiates seizure. The research aim was to determine the changes of IL-8 and IL-4 levels in children with status epilepticus, seizure with no status epilepticus, and fever with no seizure as a predictor for status epilepticus. This is a cross sectional study with 30 samples, consisted of 10 children with status epilepticus, 10 children with seizure, but no status epilepticus, and 10 children with fever, but no seizure. IL-8 and IL-4 levels were measured by ELISA. Statistical analyses were done by one-way ANOVA and Spearman's correlation test utilizing SPSS-23. The result showed a significant difference in IL-8 levels (p = 0.000), but not in IL-4 levels (p = 0.818) for status epilepticus, seizure with no status epilepticus, and fever with no seizure. There was a significant difference in IL-4/IL-8 ratio between groups (p = 0.000). There were significant correlation betweeen IL-8 level and status epilepticus, and between IL-4/IL-8 ratio and status epilepticus, but no significant correlation was found for IL-4 level.

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Hubungan Kadar Il-8 Dan Il-4 Pada Anak Dengan Status Epileptikus

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“…The recommended intravenous dosing of diazepam is approximately 0.2 mg/kg/ dose and for lorazepam 0.1 to 0.2 mg/kg/dose. 6 The difference is certainly not comparable the up to 5-fold difference in the dose used by the authors; 5 mg intrarectal diazepam for 1-to 4-yearolds and only 1 mg sublingual lorazepam for 6-to 36-month-old children. 1 Srinivas 7 (a reference quoted by Malu et al 1 ) has suggested that the sublingual dosing of lorazepam needs to be at least 8 mg (independent of the child's weight) because of its pharmacokinetic profile.…”

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“…The intravenous dosing conversion of midazolam and diazepam is also nearly 1:1, with midazolam dosing for acute seizure activity recommended at 0.1 to 0.2 mg/kg/dose. 6 Scott et al 2 found buccal midazolam to be at least as effective as rectal diazepam in treating prolonged seizures in children and adolescents. In their study, however, they used exactly the same dose (10 mg) of buccal midazolam and rectal diazepam for all their study patients.…”

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The Efficacy of Sublingual Lorazepam for Prolonged Convulsions Beyond Sub-Saharan Africa

2013

J Child Neurol

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In this issue, the study by Malu et al 1 attempts to define another potentially good home or at least out-of-hospital therapeutic option for actively seizing patients, namely, a sublingual dissolving lorazepam tablet. Unfortunately, they found sublingual lorazepam to be less efficacious in stopping seizures in children compared with rectal diazepam. However, I believe it is premature to reach that conclusion because the dose used was too low.There are a few out-of-hospital treatments available that could be administered by family members. Rectal diazepam (at a dose of 0.5 mg/kg; maximum 20 mg) is one of the most widely available commercially and arguably best known, and hence it is often used in the comparison arm of head-to-head studies. Buccal and nasal midazolam has been described and is safe and effective. [2][3][4] We, at our institutions, have been prescribing and using oral disintegrating clonazepam tablets for several years and have found them to be as effective as and less costly than rectal diazepam. 5 The dosing regimen is essentially based on child size and height-0.25 mg for an infant, 0.5 mg for a toddler, 1 mg for a child who is as tall as an adult's waist, and 2 mg for one who comes up to an adult's shoulder. 5 Even in our study, the failed cases were thought to be due to inadequate dosing.In general, the intravenous doses of diazepam and lorazepam used are probably between 1:1 and 1:2 equivalencies, with a slightly lower dose of lorazepam probably being of equal efficacy at least intravenously to diazepam. The recommended intravenous dosing of diazepam is approximately 0.2 mg/kg/ dose and for lorazepam 0.1 to 0.2 mg/kg/dose. 6 The difference is certainly not comparable the up to 5-fold difference in the dose used by the authors; 5 mg intrarectal diazepam for 1-to 4-yearolds and only 1 mg sublingual lorazepam for 6-to 36-month-old children. 1 Srinivas 7 (a reference quoted by Malu et al 1 ) has suggested that the sublingual dosing of lorazepam needs to be at least 8 mg (independent of the child's weight) because of its pharmacokinetic profile. The mouth and the rectum have similar surface areas and pH and have rich blood supplies, and the absorption occurs directly into the systemic circulation, which avoids high first-pass metabolism. 8 Although one can certainly argue that there are no studies for every single absorption rate of various benzodiazepines from different routes of administration (and even if there were, they might not necessarily directly correlate to clinical efficacy), probably the doses used of the same or similar drug for orobuccal or sublingual administration should be similar to the rectal dose. The intravenous dosing conversion of midazolam and diazepam is also nearly 1:1, with midazolam dosing for acute seizure activity recommended at 0.1 to 0.2 mg/kg/dose. 6 Scott et al 2 found buccal midazolam to be at least as effective as rectal diazepam in treating prolonged seizures in children and adolescents. In their study, however, they used exactly the same dose (10 mg) of buccal ...

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Status Epilepticus in Childhood

Cited by 2 publications

References 91 publications

Hubungan Kadar Il-8 Dan Il-4 Pada Anak Dengan Status Epileptikus

Hubungan Kadar Il-8 Dan Il-4 Pada Anak Dengan Status Epileptikus

The Efficacy of Sublingual Lorazepam for Prolonged Convulsions Beyond Sub-Saharan Africa

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