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Management of Pediatric Status Epilepticus

  • Pediatric Neurology (HS Singer, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Status epilepticus (SE) is a medical emergency consisting of persistent or recurring seizures without a return to baseline mental status. SE can be divided into subtypes based on seizure types and underlying etiologies. Management should be implemented rapidly and based on pre-determined care pathways. The aim is to terminate seizures while simultaneously identifying and managing precipitant conditions. Seizure management involves “emergent” treatment with benzodiazepines (lorazepam intravenously, midazolam intramuscularly, or diazepam rectally) followed by “urgent” therapy (phenytoin/fosphenytoin, phenobarbital, levetiracetam or valproate sodium). If seizures persist, “refractory” treatments include infusions of midazolam or pentobarbital. Prognosis is dependent on the underlying etiology and seizure persistence. This article reviews the current management strategies for pediatric convulsive SE.

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References and Recommended Reading

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  1. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23. This guideline discusses the management of status epilepticus in children, including anoverall approach, acute medical management, and anti-seizure medications.

    Article  PubMed  Google Scholar 

  2. Riviello JJ, Ashwal S, Hirtz D, et al. Practice Parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review). Neurology. 2006;67:1542–50.

    Article  PubMed  Google Scholar 

  3. Singh RK, Stephens S, Berl MM, et al. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology. 2010;74(8):636–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Chin RF, Neville BG, Peckham C, et al. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368(9531):222–9.

    Article  PubMed  Google Scholar 

  5. Berg AT, Shinnar S, Levy SR, et al. Status epilepticus in children with newly diagnosed epilepsy. Ann Neurol. 1999;45(5):618–23.

    Article  CAS  PubMed  Google Scholar 

  6. Eriksson K, Metsaranta P, Huhtala H, et al. Treatment delay and the risk of prolonged status epilepticus. Neurology. 2005;65(8):1316–8.

    Article  CAS  PubMed  Google Scholar 

  7. Lewena S, Young S. When benzodiazepines fail: how effective is second line therapy for status epilepticus in children? Emerg Med Australas. 2006;18(1):45–50.

    Article  PubMed  Google Scholar 

  8. Hayashi K, Osawa M, Aihara M, et al. Efficacy of intravenous midazolam for status epilepticus in childhood. Pediatr Neurol. 2007;36(6):366–72.

    Article  PubMed  Google Scholar 

  9. Jacob TC, Moss SJ, Jurd R. GABA(A) receptor trafficking and its role in the dynamic modulation of neuronal inhibition. Nat Rev Neurosci. 2008;9(5):331–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Goodkin HP, Joshi S, Mtchedlishvili Z, et al. Subunit-specific trafficking of GABA(A) receptors during status epilepticus. J Neurosci. 2008;28(10):2527–38.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Pakalnis A, Paolicchi J, Gilles E. Psychogenic status epilepticus in children: psychiatric and other risk factors. Neurology. 2000;54(4):969–70.

    Article  CAS  PubMed  Google Scholar 

  12. Papavasiliou A, Vassilaki N, Paraskevoulakos E, et al. Psychogenic status epilepticus in children. Epilepsy Behav. 2004;5(4):539–46.

    Article  CAS  PubMed  Google Scholar 

  13. Kirkham FJ, Wade AM, McElduff F, et al. Seizures in 204 comatose children: incidence and outcome. Intensive Care Med. 2012;38(5):853–62.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Topjian AA, Gutierrez-Colina AM, Sanchez SM, et al. Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children. Crit Care Med. 2013;31:215–23.

    Google Scholar 

  15. Abend NS, Arndt DH, Carpenter JL, et al. Electrographic seizures in pediatric ICU patients: Cohort study of risk factors and mortality. Neurology. 2013;81(4):383–91.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Wagenman KL, Blake TP, Sanchez SM, et al. Electrographic status epilepticus and long-term outcome in critically ill children. Neurology. 2014;82(5):396–404.

    Article  PubMed  Google Scholar 

  17. Payne ET, Zhao XY, Frndova H, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain. 2014;137:1429–38.

    Article  PubMed  Google Scholar 

  18. Abend NS, Gutierrez-Colina AM, Topjian AA, et al. Nonconvulsive seizures are common in critically ill children. Neurology. 2011;76(12):1071–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Williams K, Jarrar R, Buchhalter J. Continuous video-EEG monitoring in pediatric intensive care units. Epilepsia. 2011;52(6):1130–6.

    Article  PubMed  Google Scholar 

  20. Sanchez Fernandez I, Abend NS, Arndt DH, et al. Electrographic seizures after convulsive status epilepticus in children and young adults. A retrospective multicenter study. J Pediatr. 2014;164(2):339–46. This multicenter observational study addresses the use of EEG monitoring in children presenting with convulsive status epilepticus.

    Article  PubMed  Google Scholar 

  21. Cook AM, Castle A, Green A, et al. Practice variations in the management of status epilepticus. Neurocrit Care. 2012;17(1):24–30. This study summarizes current practice related to status epilepticus management, including variation across institutions.

    Article  PubMed  Google Scholar 

  22. Shorvon S, Baulac M, Cross H, et al. The drug treatment of status epilepticus in Europe: Consensus document from a workshop at the first London Colloquium on Status Epilepticus. Epilepsia. 2008;49(7):1277–86.

    PubMed  Google Scholar 

  23. Tobias JD, Berkenbosch JW. Management of status epilepticus in infants and children prior to pediatric ICU admission: deviations from the current guidelines. South Med J. 2008;101(3):268–72.

    Article  PubMed  Google Scholar 

  24. 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(2):83–7.

    Article  PubMed  Google Scholar 

  25. 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 Psychiatry. 2004;75(11):1584–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Tirupathi S, McMenamin JB, Webb DW. Analysis of factors influencing admission to intensive care following convulsive status epilepticus in children. Seizure. 2009;18(9):630–3.

    Article  PubMed  Google Scholar 

  27. 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(2):162–8.

    Article  CAS  PubMed  Google Scholar 

  28. Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev. 2008;3:CD001905.

    PubMed  Google Scholar 

  29. 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(6):575–82.

    Article  PubMed  Google Scholar 

  30. Shaner DM, McCurdy SA, Herring MO, et al. Treatment of status epileticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology. 1988;38:202–7.

    Article  CAS  PubMed  Google Scholar 

  31. Crawford TO, Mitchell WG, Fishman LS, et al. Very-high-dose phenobarbital for refractory status epilepticus in children. Neurology. 1988;38(7):1035–40.

    Article  CAS  PubMed  Google Scholar 

  32. Wilmshurst JM, van der Walt JS, Ackermann S, et al. Rescue therapy with high-dose oral phenobarbitone loading for refractory status epilepticus. J Paediatr Child Health. 2010;46(1‒2):17–22.

    Article  PubMed  Google Scholar 

  33. Lin JJ, Lin KL, Wang HS, et al. Effect of topiramate, in combination with lidocaine, and phenobarbital, in acute encephalitis with refractory repetitive partial seizures. Brain Dev. 2009;31(8):605–11.

    Article  PubMed  Google Scholar 

  34. 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(10):1191–7.

    Article  PubMed  Google Scholar 

  35. Yu KT, Mills S, Thompson N, et al. Safety and efficacy of intravenous valproate in pediatric status epilepticus and acute repetitive seizures. Epilepsia. 2003;44(5):724–6.

    Article  CAS  PubMed  Google Scholar 

  36. Uberall MA, Trollmann R, Wunsiedler U, et al. Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology. 2000;54(11):2188–9.

    Article  CAS  PubMed  Google Scholar 

  37. McTague A, Kneen R, Kumar R, et al. Intravenous levetiracetam in acute repetitive seizures and status epilepticus in children: experience from a children's hospital. Seizure. 2012;21(7):529–34.

    Article  CAS  PubMed  Google Scholar 

  38. Reiter PD, Huff AD, Knupp KG, et al. Intravenous levetiracetam in the management of acute seizures in children. Pediatr Neurol. 2010;43(2):117–21.

    Article  PubMed  Google Scholar 

  39. Kirmani BF, Crisp ED, Kayani S, et al. Role of intravenous levetiracetam in acute seizure management of children. Pediatr Neurol. 2009;41(1):37–9.

    Article  PubMed  Google Scholar 

  40. Akyildiz BN, Kumandas S. Treatment of pediatric refractory status epilepticus with topiramate. Childs Nerv Syst. 2011;27(9):1425–30.

    Article  PubMed  Google Scholar 

  41. Gilbert DL, Gartside PS, Glauser TA. Efficacy and mortality in treatment of refractory generalized convulsive status epilepticus in children: a meta-analysis. J Child Neurol. 1999;14(9):602–9.

    Article  CAS  PubMed  Google Scholar 

  42. Singhi S, Murthy A, Singhi P, et al. Continuous midazolam versus diazepam infusion for refractory convulsive status epilepticus. J Child Neurol. 2002;17(2):106–10.

    Article  PubMed  Google Scholar 

  43. Holtkamp M, Masuhr F, Harms L, et al. The management of refractory generalised convulsive and complex partial status epilepticus in three European countries: a survey among epileptologists and critical care neurologists. J Neurol Neurosurg Psychiatry. 2003;74(8):1095–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Claassen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. J Neurol Sci. 2003;211(1‒2):37–41.

    Article  PubMed  Google Scholar 

  45. Kim SJ, Lee DY, Kim JS. Neurologic outcomes of pediatric epileptic patients with pentobarbital coma. Pediatr Neurol. 2001;25(3):217–20.

    Article  CAS  PubMed  Google Scholar 

  46. Barberio M, Reiter PD, Kaufman J, et al. Continuous infusion pentobarbital for refractory status epilepticus in children. J Child Neurol. 2012;27(6):721–6.

    Article  PubMed  Google Scholar 

  47. Rosati A, L'Erario M, Ilvento L, et al. Efficacy and safety of ketamine in refractory status epilepticus in children. Neurology. 2012;79(24):2355–8.

    Article  CAS  PubMed  Google Scholar 

  48. Ben Yehuda Y, Watemberg N. Ketamine increases opening cerebrospinal pressure in children undergoing lumbar puncture. J Child Neurol. 2006;21(6):441–3.

    PubMed  Google Scholar 

  49. Himmelseher S, Durieux ME. Revising a dogma: ketamine for patients with neurological injury? Anesth Analg. 2005;101(2):524–34.

    Article  CAS  PubMed  Google Scholar 

  50. van Gestel JP, Blusse van Oud-Alblas HJ, Malingre M, et al. Propofol and thiopental for refractory status epilepticus in children. Neurology. 2005;65(4):591–2.

    Article  PubMed  Google Scholar 

  51. Niermeijer JM, Uiterwaal CS, Van Donselaar CA. Propofol in status epilepticus: little evidence, many dangers? J Neurol. 2003;250(10):1237–40.

    Article  CAS  PubMed  Google Scholar 

  52. Kofke WA, Young RS, Davis P, et al. Isoflurane for refractory status epilepticus: a clinical series. Anesthesiology. 1989;71(5):653–9.

    Article  CAS  PubMed  Google Scholar 

  53. Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004;61(8):1254–9.

    PubMed  Google Scholar 

  54. 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(6):414–9.

    Article  PubMed  Google Scholar 

  55. Hofler J, Trinka E. Lacosamide as a new treatment option in status epilepticus. Epilepsia. 2013;54(3):393–404.

    Article  PubMed  Google Scholar 

  56. Shiloh-Malawsky Y, Fan Z, Greenwood R, et al. Successful treatment of childhood prolonged refractory status epilepticus with lacosamide. Seizure. 2011;20(7):586–8.

    Article  PubMed  Google Scholar 

  57. Yoshii A, Takeoka M, Kelly PJ, et al. Focal status epilepticus as atypical presentation of pyridoxine-dependent epilepsy. J Child Neurol. 2005;20(8):696–8.

    Article  PubMed  Google Scholar 

  58. Goutieres F, Aicardi J. Atypical presentations of pyridoxine-dependent seizures: a treatable cause of intractable epilepsy in infants. Ann Neurol. 1985;17(2):117–20.

    Article  CAS  PubMed  Google Scholar 

  59. Chou ML, Wang HS, Hung PC, et al. Late-onset pyridoxine-dependent seizures: report of two cases. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1995;36(6):434–7.

    CAS  PubMed  Google Scholar 

  60. Kluger G, Blank R, Paul K, et al. Pyridoxine-dependent epilepsy: normal outcome in a patient with late diagnosis after prolonged status epilepticus causing cortical blindness. Neuropediatrics. 2008;39(5):276–9.

    Article  CAS  PubMed  Google Scholar 

  61. Russell KE, Mulligan SR, Mallory LA. Diagnosis of pyridoxine-dependent seizures in a nineteen-year-old patient. Pediatr Neurol. 2012;47(2):141–3.

    Article  PubMed  Google Scholar 

  62. Wang HS, Kuo MF, Chou ML, et al. Pyridoxal phosphate is better than pyridoxine for controlling idiopathic intractable epilepsy. Arch Dis Child. 2005;90(5):512–5.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Gospe Jr SM. Pyridoxine-dependent seizures: new genetic and biochemical clues to help with diagnosis and treatment. Curr Opin Neurol. 2006;19(2):148–53.

    Article  CAS  PubMed  Google Scholar 

  64. Yeghiazaryan NS, Zara F, Capovilla G, et al. Pyridoxine-dependent epilepsy: an under-recognised cause of intractable seizures. J Paediatr Child Health. 2012;48(3):E113–5.

    Article  PubMed  Google Scholar 

  65. Strzelczyk A, Reif PS, Bauer S, et al. Intravenous initiation and maintenance of ketogenic diet: Proof of concept in super-refractory status epilepticus. Seizure. 2013;22(7):581–3.

    Article  PubMed  Google Scholar 

  66. Cervenka MC, Kossoff EH. Dietary treatment of intractable epilepsy. Continuum (Minneap Minn). 2013;19(3 Epilepsy):756–66.

    Google Scholar 

  67. Nordli DR, De Vivo DC. The Ketogenic Diet. In: Wyllie E, editor. Wyllie's treatment of Epilepsy. Philadelphia: Lippincott, Williams and Wilkins; 2011. p. p. 79–6.

    Google Scholar 

  68. Kossoff EH, Nabbout R. Use of dietary therapy for status epilepticus. J Child Neurol. 2013;28(8):1049–51.

    Article  PubMed  Google Scholar 

  69. Nabbout R, Mazzuca M, Hubert P, et al. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia. 2010;51(10):2033–7.

    Article  PubMed  Google Scholar 

  70. Bhatia S, Ahmad F, Miller I, et al. Surgical treatment of refractory status epilepticus in children. J Neurosurg Pediatr. 2013;12(4):360–6.

    Article  PubMed  Google Scholar 

  71. Guilliams K, Rosen M, Buttram S, et al. Hypothermia for pediatric refractory status epilepticus. Epilepsia. 2013;54:1586–94.

    Article  PubMed Central  PubMed  Google Scholar 

  72. Lin JJ, Lin KL, Hsia SH, et al. Therapeutic hypothermia for febrile infection-related epilepsy syndrome in two patients. Pediatr Neurol. 2012;47(6):448–50.

    Article  PubMed  Google Scholar 

  73. Weiner RD, Coffet CE, Fochtmann L. The practice of ECT: recommendations for treatment, training and privileging. 2nd ed. Washington DC: American Psychiatric Press; 2001.

    Google Scholar 

  74. Lambrecq V, Villega F, Marchal C, et al. Refractory status epilepticus: electroconvulsive therapy as a possible therapeutic strategy. Seizure. 2012;21(9):661–4.

    Article  PubMed  Google Scholar 

  75. Cristancho MA, Alici Y, Augoustides JG, et al. Uncommon but serious complications associated with electroconvulsive therapy: recognition and management for the clinician. Curr Psychiatry Rep. 2008;10(6):474–80.

    Article  PubMed  Google Scholar 

  76. Srzich A, Turbott J. Nonconvulsive generalised status epilepticus following electroconvulsive therapy. Aust N Z J Psychiatry. 2000;34(2):334–6.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Nicholas Abend is funded by NIH K23NS076550.Dr. Abend has also given expert testimony in medico-legal cases and receives royalties from Demos Medical Publishing for “Pediatric Neurocritical Care.”

Tobias Loddenkemper receives support from the National Institutes of Health/NINDS, a Career Development Fellowship Award from Harvard Medical School and Boston Children's Hospital, the Program for Quality and Safety at Boston Children's Hospital, the Payer Provider Quality Initiative, The American Epilepsy Society, The Epilepsy Foundation of America, the Center for Integration of Medicine and Innovative Technology, the Epilepsy Therapy Project, the Pediatric Epilepsy Research Foundation, the Danny Did Foundation, the HHV6 Foundation, and from investigator initiated research grants from Lundbeck and Eisai. Dr. Loddenkemper also serves on the Laboratory Accreditation Board for Long Term (Epilepsy and Intensive Care Unit) Monitoring, on the Council of the American Clinical Neurophysiology Society, on the American Board of Clinical Neurophysiology, as an Associate Editor for Seizure.

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This article does not contain any studies with human or animal subjects performed by any of the authors

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Authors and Affiliations

  1. Departments of Neurology and Pediatrics, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, 3501 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Nicholas S. Abend MD

  2. Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Tobias Loddenkemper MD

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Correspondence to Nicholas S. Abend MD.

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This article is part of the Topical Collection on Pediatric Neurology

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Abend, N.S., Loddenkemper, T. Management of Pediatric Status Epilepticus. Curr Treat Options Neurol 16, 301 (2014). https://doi.org/10.1007/s11940-014-0301-x

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