Status Epilepticus—Work-Up and Management in Children

Abstract

Status epilepticus (SE) is one of the most common neurological emergencies in children and has a mortality of 2 to 4%. Admissions for SE are very resource-consuming, especially in refractory and super-refractory SE. An increasing understanding of the pathophysiology of SE leaves room for improving SE treatment protocols, including medication choice and timing. Selecting the most efficacious medications and giving them in a timely manner may improve outcomes. Benzodiazepines are commonly used as first line and they can be used in the prehospital setting, where most SE episodes begin. The diagnostic work-up should start simultaneously to initial treatment, or as soon as possible, to detect potentially treatable causes of SE. Although most etiologies are recognized after the first evaluation, the detection of more unusual causes may become challenging in selected cases. SE is a life-threatening medical emergency in which prompt and efficacious treatment may improve outcomes. We provide a summary of existing evidence to guide clinical decisions regarding the work-up and treatment of SE in pediatric patients.

Management of Status Epilepticus by Different Pediatric Departments: Neurology, Intensive Care, and Emergency Medicine

“…Early elucidation of the etiology of SE provides guidance for treatment steps; however, recognition of more unusual reasons may become challenging in selected cases [9, 10]. For example, autoimmune encephalitis was previously thought to be an extremely rare disease; a recent study in Minnesota highlighted the prevalence and incidence of autoimmune encephalitis being similar to infectious encephalitis [29].…”

“…In the second section, the knowledge of the definitions of SE (questions 7, 8, 9, 16, 18) was evaluated. In the third section, they were asked about the first-, second-, and third-line antiseizure medications and also preferences of neuroimaging and EEG monitoring (questions 10,11,12,13,14,15,17,19,20,21). In the fourth section of the questionnaire, specialists were asked about their opinions regarding SE prognosis (Question 22).…”

“…In the fourth section of the questionnaire, specialists were asked about their opinions regarding SE prognosis (Question 22). The statements were prepared by Dedeoğlu Ö., Akça H., and Emeksiz S. after a comprehensive discussion on guidelines and recent articles [9, 10, 12, 13]. After the authors arrived at consensus, relevance of the statements was judged independently by two competent authors in this field (Kartal A. and Kurt N.Ç.).…”

“…In a study comparing medically treated and untreated seizure episodes, differences were found in terms of age and etiology, and the relationship between treatment delay and response became significant after 30 min [4]. Although recent findings improve treatment strategies for pediatric SE [5][6][7], optimal first-, second-, and third-line steps for SE, refractory SE, and super-refractory SE are unclear [8][9][10][11]. In our country, decisions in SE management are largely based on expert opinion.…”

Treatment Guideline Nonadherence Pretransport Associated With Need for Higher Level of Care in Children Transferred to a Pediatric Tertiary Care Center for Status Epilepticus

“…These variables were selected a priori based on previous literature and clinician expertise. 14,15 There were too few patients who were tracheostomy dependent to include in the model. The proportional odds assumption was verified by comparing the proportional odds model to a fully specified logistic model assuming 3 separate levels with a likelihood ratio test.…”