Time from convulsive status epilepticus onset to anticonvulsant administration in children

Abstract

Objective: To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED).Methods: This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE. Results:We enrolled 81 patients (44 male) with a median age of 3.6 years. The first, second, and third AED doses were administered at a median (p 25 -p 75 ) time of 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes after SE onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2-3) doses of benzodiazepines were administered before switching to nonbenzodiazepine AEDs. The first and second doses of nonbenzodiazepine AEDs were administered at 69 (40-120) minutes and 120 (75-296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5-15) minutes and 16 (10-40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset). Conclusions:The time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the prehospital and in-hospital settings. Status epilepticus (SE) is one of the most common pediatric neurologic emergencies.1 It has a mortality of 0%-3% 2-7 and morbidity that includes cognitive and neurodevelopmental impairments, epilepsy, and recurrent SE.2,8-10 SE is often refractory to the initial antiepileptic drugs (AEDs), 11,12 and refractory SE is associated with poor outcome. 12 Patient age, etiology, and SE duration all affect outcome, 5,9,13 but only SE duration is a potentially modifiable factor by rapid AED treatment. By convention, the treatment of convulsive SE is a sequence of AEDs, typically

Long‐term outcomes of status epilepticus: A critical assessment

“…Delays in time to treatment are independently associated with worse outcomes in the short term (higher mortality, higher need for continuous infusions, longer convulsive duration, and more frequent hypotension) 1, 2, 3, 33, 82, 83. Families and caregivers play a crucial role, as timely treatment is often possible if families and caregivers administer a rescue medication at home and quickly call emergency services 84, 85, 86. However, a survey of 100 families of patients with epilepsy showed that 87% had a rescue medication prescription, but only 61% of them reported receiving training on how to use it 86, 87.…”

“…However, a survey of 100 families of patients with epilepsy showed that 87% had a rescue medication prescription, but only 61% of them reported receiving training on how to use it 86, 87. Furthermore, a study showed that only 37.5% of patients received prehospital treatment 85. Improving these factors could impact short‐term outcomes.…”

Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

“…Both adults [13][14][15][16][17] and children [17][18][19][20] receive antiepileptic drugs (AEDs) later than recommended by most SE guidelines. [21][22][23] Most episodes of pediatric SE occur in children with no history of seizures.…”

“…[21][22][23] Most episodes of pediatric SE occur in children with no history of seizures. 1,19 However, there are no data on whether having a history of seizures or SE results in more timely treatment-including initial abortive medication and escalation of therapies-and better outcomes.…”

“…Detailed data on time to treatment of the first 81 patients in this population have been reported. 19 Outcome variables. The primary descriptive measures for rSE management were the time from seizure onset to the administration of the first BZD, first non-BZD AED, and first continuous infusion.…”