Treatment of Pediatric Status Epilepticus
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Status epilepticus is characterized by a prolonged, self-sustaining seizure or repeated seizures without return to baseline. The clinical manifestations of status epilepticus in children and adults range from overt generalized convulsions to more subtle behavioral manifestations, including unresponsiveness in the setting of the intensive care unit. Status epilepticus is the most common neurologic emergency of childhood. A large proportion of these episodes are the result of a prolonged febrile seizure or an acute symptomatic etiology. Fortunately, status epilepticus occurs without consequence for many children, but for others, it is correlated with long-term neurologic dysfunction or death. Treatment of status epilepticus should commence promptly upon its recognition, using predefined treatment protocols. The goal of treatment is the rapid termination of the seizure, to minimize the acute and chronic effects of this emergency and to allow for the prompt assessment and management of the underlying precipitant. Currently, the drug class of first choice in the in-hospital and out-of-hospital treatment of status epilepticus is the benzodiazepines, which may need to be quickly followed by a next-line agent, as the efficacy of the benzodiazepines is negatively correlated with seizure duration. Traditionally, these next-line agents have included phenobarbital and phenytoin, but emerging evidence supports the use of intravenous formulations of other antiepileptic drugs. If the first two agents fail, high-dose intravenous midazolam or anesthetic therapy should be rapidly initiated. This paper reviews the current treatment options and strategies for pediatric patients with status epilepticus.
- Chen JWY, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5:246–56. CrossRef
- DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46:1029–35.
- Chin RF, Neville BG, Peckham, et al. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368:222–9. CrossRef
- Lewena S, Pennington V, Acworth J, et al: Emergency management of pediatric convulsive status epilepticus: a multicenter study of 542 patients. Pediatr Emerg Care 2009;25:83–7. CrossRef
- Kravljanac R, Jovic N, Djuric M, et al.: Outcome of status epilepticus in children treated in the intensive care unit: a study of 302 cases, Epilepsia 2011;52:358–63.
- Neligan A, Shorvon SD. Prognostic factors, morbidity and mortality in tonic-clonic status epilepticus: a review. Epilepsy Res. 2011;93:1–10. CrossRef
- Abend, NS, Gutierrez-Colina AM, Topjian AA, et al.: Nonconvulsive seizures are common in critically ill children. Neurology 2011;76:1071–7. CrossRef
- Riviello Jr JJ, Ashwal S, Hirtz D, et al. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2006;67:1542–50. CrossRef
- Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology. 2003;61:1066–73.
- Loddenkemper T, Nichol SM, Allred EN, et al. Fears and promises of comparative effectiveness research. Acta Paediatr. 2010;99:1311–3. CrossRef
- Shinnar S. Who is at risk for prolonged seizures? J Child Neurol. 2007;22(5 Suppl):14S–20S. CrossRef
- Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998;339:792–8. CrossRef
- Chin RF, Neville BG, Peckham C, et al. Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol. 2008;7:696–703. CrossRef
- Lambrechtsen FA, Buchhalter JR. Aborted and refractory status epilepticus in children: a comparative analysis. Epilepsia. 2008;49:615–25. CrossRef
- Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40:120–2. CrossRef
- Mpimbaza A, Ndeezi G, Staedke S, et al. Comparison of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children: a randomized clinical trial. Pediatrics. 2008;121:e58–64. CrossRef
- Holsti M, Dudley N, Schunk J, et al.: Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Ped Adolesc Med 2010;164:747–53. CrossRef
- Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345:631–7. CrossRef
- Kapur J. Prehospital treatment of status epilepticus with benzodiazepines is effective and safe. Epilepsy Curr. 2002;2:121–4. CrossRef
- Aranda A, Foucart G, Ducasse JL, et al. Generalized convulsive status epilepticus management in adults: a cohort study with evaluation of professional practice. Epilepsia. 2010;51:2159–67. CrossRef
- Chin RF, Verhulst L, Neville BG, et al. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psych. 2004;75:1584–8. CrossRef
- Goodkin HP, Kapur J. The impact of diazepam’s discovery on the treatment and understanding of status epilepticus. Epilepsia. 2009;50:2011–8. CrossRef
- Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev. 2008;16:CD001905.
- McMullan J, Sasson C, Pancioli A, et al. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med. 2010;17:575–82. CrossRef
- Zaw W, Knoppert DC, da Silva O. Flumazenil’s reversal of myoclonic-like movements associated with midazolam in term newborns. Pharmacotherapy. 2001;21:642–6. CrossRef
- Sreenath TG, Gupta P, Sharma KK, et al.: Lorazepam versus diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children: a randomized controlled trial. Eur J Paediatr Neurol 2010;14:162–8. CrossRef
- Appleton RE, Gill A. Adverse events associated with intravenous phenytoin in children: a prospective study. Seizure. 2003;12:369–72. CrossRef
- Wilmshurst JM, van der Walt JS, Ackermann SA, et al. Rescue therapy with high-dose oral phenobarbitone loading for refractory status epilepticus. J Paediatr Child Health. 2010;46:17–22. CrossRef
- Mehta V, Singhi P, Singhi S. Intravenous sodium valproate versus diazepam infusion for the control of refractory status epilepticus in children: a randomized controlled trial. J Child Neurol. 2007;22:1191–7. CrossRef
- Uberall MA, Trollmann R, Wunsiedler U, et al. Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology. 2000;13:2188–9.
- Reiter PD, Huff AD, Knupp KG, et al. Intravenous levetiracetam in the management of acute seizures in children. Pediatr Neurol. 2010;43:117–21. CrossRef
- Barrueto Jr F, Williams K, Howland MA, et al. A case of levetiracetam (Keppra) poisoning with clinical and toxicokinetic data. J Toxicol Clin Toxicol. 2002;40:881–4. CrossRef
- Shiloh-Malawsky Y, Fan Z, Greenwood R, et al. Successful treatment of childhood prolonged refractory status epilepticus with lacosamide. Seizure. 2011;20:586–8. CrossRef
- Guilhoto LM, Loddenkemper T, Gooty VD, et al. Experience with lacosamide in a series of children with drug-resistant focal epilepsy. Pediatr Neurol. 2011;44:414–9. CrossRef
- Riviello Jr JJ. Seizures in the context of acute illness. Curr Opin Pediatr. 2009;21:731–6. CrossRef
- Rossetti AO, Milligan TA, Vulliemoz S, et al. A randomized trial for the treatment of refractory status epilepticus. Neurocrit Care. 2011;14:4–10. CrossRef
- Sahin M, Menache CC, Holmes GL, et al. Prolonged treatment for acute symptomatic refractory status epilepticus: outcome in children. Neurology. 2003;61:398–401.
- Hayashi K, Osawa M, Aihara M, et al. Efficacy of intravenous midazolam for status epilepticus in childhood. Pediatr Neurol. 2007;36:366–72. CrossRef
- Kim SJ, Lee DY, Kim JS. Neurologic outcomes of pediatric epileptic patients with pentobarbital coma. Pediatr Neurol. 2001;25:217–20. CrossRef
- Iyer VN, Hoel R, Rabinstein AA. Propofol infusion syndrome in patients with refractory status epilepticus: an 11-year clinical experience. Crit Care Med. 2009;37:3024–30. CrossRef
- da Silva SS, Wong R, Coquillon P, et al. Partial-exchange blood transfusion: an effective method for preventing mortality in a child with propofol infusion syndrome. Pediatrics. 2010;125:e1493–9. CrossRef
- Hsieh CY, Sung PS, Tsai JJ, et al. Terminating prolonged refractory status epilepticus using ketamine. Clin Neuropharmacol. 2010;33:165–7. CrossRef
- Mewasingh LD, Sekhara T, Aeby A, et al. Oral ketamine in paediatric non-convulsive status epilepticus. Seizure. 2003;12:483–9. CrossRef
- Akyildiz BN, Kumandas S. Treatment of pediatric refractory status epilepticus with topiramate. Childs Nerv Syst. 2011;27:1425–30. CrossRef
- Novy J, Rossetti AO. Oral pregabalin as an add-on treatment for status epilepticus. Epilepsia. 2010;51:2207–10. CrossRef
- Vendrame M, Loddenkemper T. Surgical treatment of refractory status epilepticus in children: candidate selection and outcome. Semin Pediatr Neurol. 2010;17:182–9. CrossRef
- De Herdt V, Waterschoot L, Vonck K, et al. Vagus nerve stimulation for refractory status epilepticus. Eur J Paediatr Neurol. 2009;13:286–9. CrossRef
- Corry JJ, Dhar R, Murphy T, et al. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008;9:189–97. CrossRef
- Shin HW, O’Donovan CA, Boggs JG, et al. Successful ECT treatment for medically refractory nonconvulsive status epilepticus in pediatric patient. Seizure. 2011;20:433–6. CrossRef
- Kamel H, Cornes SB, Hegde M, et al. Electroconvulsive therapy for refractory status epilepticus: a case series. Neurocrit Care. 2010;12:204–10. CrossRef
- Treatment of Pediatric Status Epilepticus
Current Treatment Options in Neurology
Volume 13, Issue 6 , pp 560-573
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Harvard Medical School, Division of Epilepsy and Clinical Neurophysiology, Fegan 9, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA, 02115, USA
- 2. Departments of Neurology and Pediatrics, University of Virginia Health Systems, PO Box 800394, Charlottesville, VA, 22908, USA