Status epilepticus in children

  • Rani K. Singh
  • William D. GaillardEmail author


Status epilepticus is a common, life-threatening medical emergency in pediatric patients. Recent medical literature has focused on identifying risks and treatment options. This article highlights the epidemiology of status epilepticus, both convulsive and nonconvulsive, in children. It also reviews the recommended medications for first-line treatment of status epilepticus and refractory status epilepticus. Emphasis is placed on future pharmacotherapies and consideration of neurosurgical intervention when indicated.


Valproic Acid Status Epilepticus Topiramate Pediatric Intensive Care Unit Levetiracetam 
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References and Recommended Reading

  1. 1.
    Shorvon S: The concept of status epilepticus and its history. In Status Epilepticus: Its Clinical Features and Treatment in Children and Adults. Cambridge: Cambridge University Press; 1994:1–16.Google Scholar
  2. 2.
    Commission on Classification and Terminology of the International League Against Epilepsy: Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989, 30:389–399.CrossRefGoogle Scholar
  3. 3.
    Chamberlain JM, Altieri MA, Futterman C, et al.: A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care 1997, 13:92–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Lowenstein DH, Bleck T, Macdonald RL: It’s time to revise the definition of SE. Epilepsia 1999, 40:120–122.PubMedCrossRefGoogle Scholar
  5. 5.
    Hussein N, Appleton R, Thorburn K: Aetiology, course, and outcome of children admitted to paediatric intensive care with convulsive status epilepticus: a retrospective 5-year review. Seizure 2007, 16:305–312.CrossRefGoogle Scholar
  6. 6.
    Raspall-Chaure M, Chin RF, Neville BG, et al.: Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol 2006, 5:769–779.PubMedCrossRefGoogle Scholar
  7. 7.
    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, 368:222–229.PubMedCrossRefGoogle Scholar
  8. 8.
    Nishiyama I, Ohtsuka Y, Tsuda T, et al.: An epidemiological study of children with status epilepticus in Okayama, Japan. Epilepsia 2007, 48:1133–1137.PubMedCrossRefGoogle Scholar
  9. 9.
    Wu YW, Shek DW, Garcia PA, et al.: Incidence and mortality of generalized convulsive status epilepticus in California. Neurology 2002, 58:1070–1076.PubMedGoogle Scholar
  10. 10.
    Novak G, Maytal J, Alshansky A, et al.: Risk factors for status epilepticus in children with symptomatic epilepsy. Neurology 1997, 49:533–537.PubMedGoogle Scholar
  11. 11.
    Berg AT, Shinnar S, Testa FM, et al.: Status epilepticus after the initial diagnosis of epilepsy in children. Neurology 2004, 62:1027–1034.CrossRefGoogle Scholar
  12. 12.
    Sillanpaa M, Shinnar S: Status epilepticus in a population-based cohort with childhood-onset epilepsy in Finland. Ann Neurol 2002, 52:303–310.PubMedCrossRefGoogle Scholar
  13. 13.
    Karasalihoglu S, Oner N, Celtik C, et al.: Risk factors of status epilepticus in children. Pediatrics Int 2003, 45:429–434.CrossRefGoogle Scholar
  14. 14.
    Shinnar S, Maytal J, Krasnoff L, et al.: Recurrent status epilepticus in children. Ann Neurol 1992, 31:598–604.PubMedCrossRefGoogle Scholar
  15. 15.
    Hesdorffer DC, Logroscino G, Cascion GD, et al.: Recurrence of afebrile status epilepticus in a population-based study in Rochester, MN. Neurology 2007, 69:73–78.PubMedCrossRefGoogle Scholar
  16. 16.
    Mikaeloff Y, Jambaque I, Hertz-Pannier L, et al.: Devastating epileptic encephalopathy in school-aged children (DESC): a pseudo encephalitis. Epilepsy Res 2006, 69:67–79.PubMedCrossRefGoogle Scholar
  17. 17.
    Young GB, Jordan KG, Doig GS: An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring. Neurology 1996, 47:83–89.PubMedGoogle Scholar
  18. 18.
    Claassen J, Mayer SA, Kowalski RG, et al.: Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004, 62:1743–1748.PubMedGoogle Scholar
  19. 19.
    Tay SK, Hirsch LJ, Leary L, et al.: Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia 2006, 47:1503–1509.CrossRefGoogle Scholar
  20. 20.
    Abend NS, Dlugos DJ: Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol 2007, 37:165–170.PubMedCrossRefGoogle Scholar
  21. 21.
    Saengpattrachai M, Sharma R, Hunjan A, et al.: Nonconvulsive seizures in the pediatric intensive care unit: etiology, EEG, and brain imaging findings. Epilepsia 2006, 47:1510–1518.PubMedCrossRefGoogle Scholar
  22. 22.
    Treiman DM, Walton NY, Kendrick C: A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res 1990, 5:49–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Pandian JD, Cascion GD, So EL, et al.: Digital video-electroencephalographic monitoring in the neurological-neurosurgical intensive care unit: clinical features and outcome. Arch Neurol 2004, 61:1090–1094.PubMedCrossRefGoogle Scholar
  24. 24.
    Treiman DM, Meyers PD, Walton NY, et al.: A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med 1998, 339:792–798.PubMedCrossRefGoogle Scholar
  25. 25.
    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, 345:631–637.PubMedCrossRefGoogle Scholar
  26. 26.
    Alldredge BK, Wall DB, Ferriero DM: Effect of prehospital treatment on the outcome of status epilepticus in children. Pediatric Neurol 1995, 12:213–216.CrossRefGoogle Scholar
  27. 27.
    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, 75:1584–1588.PubMedCrossRefGoogle Scholar
  28. 28.
    Agarwal P, Kumar N, Chandra R, et al.: Randomized study of IV valproate and phenytoin in status epilepticus. Seizure 2007, 116:527–532.CrossRefGoogle Scholar
  29. 29.
    Morton LD: Clinical experience with fosphenytoin in children. J Child Neurol 1998, 13:S19–S22.PubMedGoogle Scholar
  30. 30.
    Crawford TO, Mitchell WG, Fishman LS, et al.: Very-high dose phenobarbital for refractory status epilepticus in children. Neurology 1988, 38:1035–1040.PubMedGoogle Scholar
  31. 31.
    Misra UK, Jayantee K, Patel R: Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology 2006, 67:340–342.PubMedCrossRefGoogle Scholar
  32. 32.
    Yu KT, Mills S, Thompson N, et al.: Safety and efficacy of IV valproate in pediatric status epilepticus and acute repetitive seizures. Epilepsia 2003, 44:724–726.PubMedCrossRefGoogle Scholar
  33. 33.
    Uberall M, Trollman R, Wunsiedler U, et al.: Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology 2000, 54:2188–2199.PubMedGoogle Scholar
  34. 34.
    Holmes GL, Riviello JJ: Midazolam and pentobarbital for refractory status epilepticus. Pediatr Neurol 1999, 20:259–264.PubMedCrossRefGoogle Scholar
  35. 35.
    Hayashi K, Osawa M, Aihara M, et al.: Efficacy of intravenous midazolam for status epilepticus in childhood. Pediatr Neurol 2007, 36:366–372.PubMedCrossRefGoogle Scholar
  36. 36.
    Morrison G, Gibbons E, Whitehouse WP: High-dose midazolam therapy for refractory status epilepticus in children. Intensive Care Med 2006, 32:2070–2076.PubMedCrossRefGoogle Scholar
  37. 37.
    Brevoord JC, Joosten KF, Arts WF, et al.: Status epilepticus: clinical analysis of a treatment protocol based on midazolam and phenytoin. J Child Neurol 2005, 20:476–481.PubMedGoogle Scholar
  38. 38.
    Parviainen I, Uusaro A, Kälviäinen R, et al.: Propofol in the treatment of refractory status epilepticus. Intensive Care Med 2006, 32:1075–1079.PubMedCrossRefGoogle Scholar
  39. 39.
    Parke TJ, Stevens JE, Rice AS, et al.: Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 1992, 305:613–616.PubMedCrossRefGoogle Scholar
  40. 40.
    Mirsattari SM, Sharpe MD, Young B: Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 2004, 61:1254–1259.PubMedCrossRefGoogle Scholar
  41. 41.
    van Gestel JP, Blusse van Oud-Alblas HJ, Malingre M, et al.: Propofol and thiopental for refractory status epilepticus in children. Neurology 2005, 65:591–592.PubMedCrossRefGoogle Scholar
  42. 42.
    Patel NC, Landan IR, Jeffrey Levin J, et al.: The use of levetiracetam in refractory status epilepticus. Seizure 2006, 15:137–141.PubMedCrossRefGoogle Scholar
  43. 43.
    Rosetti A, Bromfield E: Levetiracetam in the treatment of status epilepticus in adults: a study of 13 episodes. Eur Neurol 2005, 54:34–38.CrossRefGoogle Scholar
  44. 44.
    Ramael S, Daoust A, Otoul C, et al.: Levetiracetam intravenous infusion: a randomized, placebo-controlled safety and pharmacokinetic study. Epilepsia 2006, 47:1128–1135.PubMedCrossRefGoogle Scholar
  45. 45.
    Towne AR, Garnett LK, Waterhouse EJ, et al.: The use of topiramate in refractory status epilepticus. Neurology 2003, 60:332–334.PubMedGoogle Scholar
  46. 46.
    Glauser TA, Clarke PO, Strawsburg R: A pilot study of topiramate in the treatment of infantile spasms. Epilepsia 1998, 39:1324–1328.PubMedCrossRefGoogle Scholar
  47. 47.
    Kahriman M, Minecan D, Kutluay E, et al.: Efficacy of topiramate in children with refractory status epilepticus. Epilepsia 2003, 44:1353–1356.PubMedCrossRefGoogle Scholar
  48. 48.
    Blumkin L, Lerman-Sagie T, Houri T, et al.: Pediatric refractory partial status epilepticus responsive to topiramate. J Child Neurol 2005, 20:239–241.PubMedGoogle Scholar
  49. 49.
    Alexopoulos A, Lachhwani DK, Gupta A, et al.: Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis. Neurology 2005, 64:567–570.PubMedGoogle Scholar
  50. 50.
    Koh S, Mathern GW, Glasser G, et al.: Status epilepticus and frequent seizures: incidence and clinical characteristics in pediatric epilepsy surgery patients. Epilepsia 2005, 46:1950–1954.PubMedCrossRefGoogle Scholar
  51. 51.
    Yu-tze NG, Kerrigan JF, Rekate HL: Neurosurgical treatment of status epilepticus. J Neurosurg 2006, 105:378–381.Google Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Children’s National Medical CenterWashington, DCUSA

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