Treatment of Pediatric Status Epilepticus

Pediatric Neurology (Harvey S. Singer, Section Editor)

Opinion statement

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.

Notes

Disclosure

Dr. Loddenkemper serves on the Laboratory Accreditation Board for Long-Term (Epilepsy and ICU) Monitoring (ABRET); performs video-EEG long-term monitoring, EEGs, and other electrophysiological studies at Children’s Hospital Boston and bills for these procedures; is funded by an Early Career Physician-Scientist Award by the Milken Family Foundation and American Epilepsy Society, by the Epilepsy Foundation of America, by the Center for Integration of Medicine and Innovative Technology, by the NIH, by the Translational Research Program at Children’s Hospital Boston, by the Program for Patient Safety and Quality at Children’s Hospital Boston, and by a Career Development Fellowship Award from Harvard Medical School and Children’s Hospital Boston; and received investigator-initiated research support from Eisai Inc within the past year.

Dr. Goodkin has served as a consultant to Avanir Pharmaceuticals within the past year. He receives research support from the National Institutes of Health.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Harvard Medical School, Division of Epilepsy and Clinical Neurophysiology, Fegan 9Children’s Hospital BostonBostonUSA
  2. 2.Departments of Neurology and PediatricsUniversity of Virginia Health SystemsCharlottesvilleUSA

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