Treatment of Refractory Status Epilepticus in Childhood

Abstract

Refractory status epilepticus (RSE) is characterized by a prolonged seizure that persists despite adequate initial management. RSE accounts for almost one quarter of all status epilepticus and carries significant risk for morbidity and mortality. Treatment varies widely between institutions regarding medication choice, dose, and monitoring. Several agents including nonanesthetic antiepileptic drugs (AEDs), anesthetic AEDs, enteral AEDs, and other therapies have been used in RSE. We review the current treatment strategies for RSE, focusing on patient selection, monitoring, optimal dosing and administration of medications, efficacy, adverse effects, and treatment duration.

Gaps and opportunities in refractory status epilepticus research in children: A multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG)

“…A timely escalation of antiepileptic drugs when initial treatments fail is advocated. 9,21,39,40,87,89–92 Basic research results 14–16,93–99 as well as clinical evidence 5,6 suggests that the longer SE persists, the more resistant it becomes to treatment. In a study of 157 children (1 month to 16 years of age) with SE, a treatment delay of more than 30 min was associated with delayed seizure control.…”

Treatment of convulsive status epilepticus in childhood: Recommendations of the Italian League Against Epilepsy

“…There are no randomized trials for the treatment of refractory SE in children, but retrospective reviews can be found about the type of drug used (midazolam, sodium thiopental, propofol), as well as expert opinions and guidelines (Van Gestel et al., ; Morrison et al., ; Mehta et al., ; Abend & Dlugos, ; Prasad, ; Lampin et al., ; Friedman, ; Loddenkemper & Goodkin, ; Schreiber & Gaillard, ; Shearer & Riviello, ; Mastrangelo & Celato, ; Sasidaran et al., ) correct. The guidelines differ from country to country depending on the sedatives commercially available and the legislative regulations.…”

Застосування Топірамату При Пароксизмальних І Непароксизмальних Станах У Дітей (Науковий Огляд І Особисте Спостереження)

“…Опубликованные режимы варьируют от 10 мк/кг/сут с последующим снижением до 1-5 мг/кг/сут на протяжении 2 дней и инициации с низких доз (1 мг/кг/сут) с последующим повышением до 6-22 мг/кг/сут в течение 3-6 дней. Первый вариант кажется авторам более предпочтительным ввиду лучшей переносимости и более быстрого развития эффекта [49,50].…”