Status Epilepticus in Children

Roberts, Mont R.; Eng-Bourquin, Janet

doi:10.1016/s0733-8627(20)30362-x

Cited by 20 publications

(4 citation statements)

References 44 publications

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“…When midazolam was used in sedating doses, paradoxical agitation with disorientation, dysphoria and restlessness occurred in a small number of patients. This syndrome can be treated with flumazenil.• 12 Although no significant drug interactions have been reported with most commonly used medications in a critical care setting, the respiratory, haemodynamic and sedative effects of midazoiam may be accentuated by the concomitant use of barbiturates, narcotics, or other central nervous system depressants. In addition, caution is advised when midazolam is co-administered with drugs known to alter its metabolising enzyme systems such as erythromycin, because this may prolong the sedative effects of midazolam.'…”

Section: Management Of Potential Side-effects Of Midazolammentioning

confidence: 99%

“…Epileptic seizures were terminated within 5 to IO minutes of 0.2 mg/kg midazolam administration in 14 patients, 19-72 years of age. 12 In paediatric patients ( 4 months to 14 years old), 0.2 mg/kg midazolam terminated 93% of seizures within I to I 0 minutes of administration.'' In a study by McDonagh et al," midazolam, 0.07-0.21 mg/kg, controlled seizures within an average of two minutes in most patients.…”

Section: Clinical Experience With Midazolam In Sementioning

confidence: 99%

“…Although individuals with pre‐existing epilepsy are at high risk of developing SE, this condition occurs more frequently as a result of an acute systemic or neurological insult 8 . In adult patients without a history of seizures, the most common causes of SE include drug intoxication, alcohol withdrawal, cerebrovascular insults, anoxia, systemic and central nervous system infections, and metabolic disorders 1,9‐12 . Although less common than the preceding, brain tumours and congenital diseases may also induce status seizures 9,11 .…”

Section: Aetiology Of Status Epilepticus In the Critical Care Patientmentioning

confidence: 99%

“…Although less common than the preceding, brain tumours and congenital diseases may also induce status seizures 9,11 . In contrast to adult cases, most paediatric cases of SE are precipitated by acute systemic infections, central nervous system insults and congenital malformations 9,12 . Figure 1 illustrates the occurrence rate of causes in the adult and paediatric populations.…”

Section: Aetiology Of Status Epilepticus In the Critical Care Patientmentioning

confidence: 99%

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Treatment of Status Epilepticus With Midazolam in the Critical Care Setting

Hanley

Pozo²

2000

Int J Clinical Practice

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SUMMARYStatus epilepticus (SE) is a potentially life‐threatening condition that requires prompt and aggressive treatment. Prolonged status seizures are associated with significant physiological sequelae and neurological deficits. Although systemic events such as hyperthermia and anoxia contribute to neuronal damage, SE in and of itself can induce cell death. In general, the sooner it is brought under control, the more favourable is the prognosis. Benzodiazepines, as a group, are the most frequently used anticonvulsants in the management of status seizures. Midazolam, a water‐soluble benzodiazepine, is a potent anticonvulsant that offers many advantages over typical benzodiazepines. Because of its stability in aqueous media, midazolam dissolves in common diluents such as normal saline or dextrose water. Consequently, midazolam both intravenously (i.v.) and intramuscularly (i.m.) is well tolerated locally and is associated with less venoirritation than benzodiazepines or antiepileptics that require organic solvents. The water solubility of midazolam also allows rapid and reliable absorption of the drug from the i.m. injection site. Because it is rapidly metabolised and its metabolites are pharmacologically inactive, midazolam has a short duration of action. Most patients regain full conscious state and can be evaluated soon after the cessation of treatment. Midazolam by continuous i.v. infusion and by the i.m. route has been successfully used in the treatment of SE. Although some respiratory and haemodynamic side‐effects have been associated with midazolam, no clinically significant side‐effects were observed with its use for the indication of SE. It is suggested that midazolam is a safe and rapidly effective treatment option in the management of SE in the critical care setting. (Int J Clin Pract 2000; 54(10): 30‐35)

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Section: Management Of Potential Side-effects Of Midazolammentioning

confidence: 99%

Section: Clinical Experience With Midazolam In Sementioning

confidence: 99%

Section: Aetiology Of Status Epilepticus In the Critical Care Patientmentioning

confidence: 99%

Section: Aetiology Of Status Epilepticus In the Critical Care Patientmentioning

confidence: 99%

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Treatment of Status Epilepticus With Midazolam in the Critical Care Setting

Hanley

Pozo²

2000

Int J Clinical Practice

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Refractory status epilepticus

et al. 2006

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Status epilepticus (SE) is a frequent neurological emergency with an annual incidence of 10-20/100,000 individuals. The overall mortality is about 10-20%. Patients present with long-lasting fits or series of epileptic seizures or extended stupor and coma. Furthermore, patients with SE can suffer from a number of systemic complications possibly also due to side effects of the medical treatment. In the beginning, standardized treatment algorithms can successfully stop most SE. A minority of SE cases prove however to be refractory against the initial treatment and require intensified pharmacologic intervention with nonsedating anticonvulsive drugs or anesthetics. In some partial SE, nonpharmacological approaches (e.g., epilepsy surgery) have been used successfully. This paper reviews scientific evidence of the diagnostic approach, therapeutic options, and course of refractory SE, including nonpharmacological treatment.

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A clinical, radiological and outcome study of status epilepticus from India

Kalita

Nair

2009

J Neurol

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The objective of this study is to evaluate the clinical and radiological characteristics and the outcome of status epilepticus (SE). 117 consecutive patients with SE were evaluated including their demographics, history of epilepsy, antiepileptic drug (AED) default, comorbidities, SE type and duration. The study included 22 children, 77 adults and 18 elderly patients with SE. Blood counts, serum chemistry, ECG, cranial MRI, cerebrospinal fluid and EEG were done. Patients were treated with IV phenytoin, valproate, lorazepam or diazepam as per a fixed protocol and responses to first and second drugs were noted. Death during hospital was recorded. The etiology of SE was infection in 53.8%, drug default in 7.9%, metabolic in 14.5%, stroke in 12.8% and miscellaneous in 11% of patients. 92.3% of patients had convulsive and 7.7% nonconvulsive SE. Cranial MRI was abnormal in 62%. Infection as an etiology was more common in children, drug default and metabolic causes in adults and stroke in adults and elderly. Following first AED, SE was controlled in 50%. 30% of patients remained refractory to second AED which was related to duration of SE and mortality. 29% patients died and death was higher in elderly (44%) compared to children (14%). Acute symptomatic SE is more common in developing countries. Refractory SE is associated with SE duration and mortality.

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Status Epilepticus in Children

Cited by 20 publications

References 44 publications

Treatment of Status Epilepticus With Midazolam in the Critical Care Setting

Treatment of Status Epilepticus With Midazolam in the Critical Care Setting

Refractory status epilepticus

A clinical, radiological and outcome study of status epilepticus from India

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