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Management des Status epilepticus im Kindesalter

Deutschlandweite Umfrage

Management of status epilepticus in childhood

German nationwide survey

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Zeitschrift für Epileptologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Der Status epilepticus (SE) im Kindesalter ist nicht häufig, aber lebensbedrohlich. Die Prognose hängt von Ursache und Dauer des SE ab, sodass die rasche Diagnostik und Therapie erforderlich sind.

Material und Methode

Es wurde eine Fragebogenerhebung zum aktuellen Management des SE in allen Kinderkliniken und -abteilungen Deutschlands durchgeführt.

Ergebnisse

Von 368 versandten Fragebogen wurden 30 (8 %) zurückgesendet. Der SE wird uneinheitlich definiert. Ein Therapiestandard existiert überwiegend (87 %). Enteral ist rektales Diazepam (87 %) Mittel der 1. Wahl, bukkales Lorazepam (40 %) Mittel der 2. Wahl. Mehr als 2 Dosen Benzodiazepine würden 31 % der Antwortenden geben. Parenteral werden Diazepam (50 %) und Lorazepam (47 %) bevorzugt. Phenobarbital (40 %) ist Mittel der 2. Wahl. Im Intervall von mehr als 5 min geben 57 % der Studienteilnehmer die Medikamente. Valproat und Levetiracetam werden unterschiedlich infundiert. Auf Intensivstationen ist Midazolam Mittel der 1. Wahl (83 %) und Thiopental Mittel der 2. Wahl (50 %). Primäre Behandlungsziele sind die klinische Anfallsfreiheit (83 %), keine elektrographischen Anfälle (33 %), „Burst-suppression“-Muster (16 %) oder komplette EEG-Suppression (6 %). Es behandeln 63 % der Kliniken den fokalen SE und den Absence-Status anders als den tonisch-klonischen SE. Zusätzlich zur Intensivtherapie werden enterale Antiepileptika oder Immuntherapie von 43 % angewendet. Die ketogene Diät ist in 53 % möglich. Auf 87 % der Intensivstationen wird der SE gemeinsam mit Neuropädiatern behandelt. Ein MRT steht überall, kontinuierliches Elektroenzephalogramm (cEEG) in 50 % und amplitudenintegriertes Elektroenzephalogramm (aEEG) in 66 % zur Verfügung. Neuronale Antikörper als mögliche Ursache eines SE sind 60 % der antwortenden Ärzte bekannt.

Schlussfolgerung

Die Rücklaufquote der Fragebogen war gering. Die Antworten zu Definition, Diagnostik und Therapie waren uneinheitlich. Deshalb sind multizentrische Studien und Änderungen des aktuellen Managements zur Verbesserung der Prognose des SE im Kindesalter dringend erforderlich.

Abstract

Background

Status epilepticus (SE) in children is not frequent but life-threatening. The prognosis depends on the etiology and duration of SE; therefore, prompt diagnostics and therapy are necessary.

Material and methods

A questionnaire on the current management of SE was sent to all pediatric clinics and departments in Germany.

Results

Of the 368 questionnaires sent out a total of 30 were returned (8 %). There was a non-uniform definition of SE. Therapy protocols existed in most cases (86 %). For enteral use rectal diazepam (87 %) was preferred as first choice and buccal lorazepam (40 %) was the second choice. Of the responders 31 % would give more than 2 doses of benzodiazepines. For parenteral use diazepam (50 %) and lorazepam (47 %) were ranked first and the second choice was phenobarbital (40 %). Antiepileptic drugs were given at an interval of more than 5 min in 57 %. Valproate and levetiracetam were non-uniformly infused. In the intensive care unit (ICU) midazolam (83 %) was the medication of choice and thiopental (50 %) the first alternative. Primary therapeutic targets were no clinical seizures (83 %), no electrographic seizures (33 %), burst-suppression pattern (16 %) and complete electroencephalogram (EEG) suppression (6 %). Physicians treated focal SE and absence status differently from generalized tonic-clonic SE in 63 % and 43 % would use enteral or immune therapy during ICU treatment. A ketogenic diet was possible in 53 % of hospitals. In 87 % of the ICUs SE was treated together with neuropediatricians. Magnetic resonance imaging (MRI) was available in all units, continuous EEG (cEEG) in 50 % and amplitude integrated EEG (aEEG) in 66 %. Neuronal antibodies as a possible cause of SE was known to 60 % of responders.

Conclusion

The response rate was low. Responses to definition, diagnostics and therapy of SE were not uniform. It was therefore concluded that multicenter studies and changes in current management are urgently needed to improve the prognosis of SE in childhood.

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Literatur

  1. Abend NS, Gutierrez-Colina AM, Dlugos DJ (2010) Medical treatment of pediatric status epilepticus. Semin Pediatr Neurol 17:169–175

    Article  PubMed  Google Scholar 

  2. Abend NS, Arndt DH, Carpenter JL et al (2013) Electrographic seizures in pediatric ICU patients: cohort study of risk factors and mortality. Neurology 81:383–391

    Article  PubMed Central  PubMed  Google Scholar 

  3. Abend NS, Chapman KE, Gallentine WB et al (2013) Electroencephalographic monitoring in the pediatric intensive care unit. Curr Neurol Neurosci Rep 13:330. DOI 10.1007/s11910-012-0330-3

    Article  PubMed Central  PubMed  Google Scholar 

  4. Babl FE, Sheriff N, Borland M et al (2009) Emergency management of paediatric status epilepticus in Australia and New Zealand: practice patterns in the context of clinical practice guidelines. J Paediatr Child Health 45:541–546

    Article  PubMed  Google Scholar 

  5. Brophy GM, Bell R, Claassen J et al (2012) Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 17:3–23

    Article  PubMed  Google Scholar 

  6. Chin RF, Neville BG, Peckham C et al (2008) Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol 7:696–703

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Demeret S, Weiss N, Bolgert F, Navarro V (2013) What is specialized care in status epilepticus and in which ICU? Neurocrit Care 19:1–3

    Article  PubMed  Google Scholar 

  8. Ferlisi M, Shorvon S (2012) The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain 135:2314–2328

    Article  PubMed  Google Scholar 

  9. Fernández IS, Abend NS, Agadi S et al (2013) Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure. DOI 10.1016/j.seizure.2013.10.004

  10. Friedman J (2011) Emergency management of the paediatric patient with generalized convulsive status epilepticus. Paediatr Child Health 16:91–104

    PubMed Central  PubMed  Google Scholar 

  11. Gaspard N, Foreman B, Judd LM et al (2013) Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study. Epilepsia 54:1498–1503

    Article  CAS  PubMed  Google Scholar 

  12. Hillman J, Lehtimäki K, Peltola J, Liimatainen S (2013) Clinical significance of treatment delay in status epilepticus. Int J Emerg Med 6:6. DOI 10.1186/1865-1380-6-6

    Article  PubMed Central  PubMed  Google Scholar 

  13. Holtkamp M (2011) Treatment strategies for refractory status epilepticus. Curr Opin Crit Care 17:94–100

    Article  PubMed  Google Scholar 

  14. Ishikawa N, Kobayashi Y, Kobayashi M (2010) A case of frontal lobe epilepsy in which amplitude-integrated EEG combined with conventional EEG was useful for evaluating clusters of seizures. Epilepsy Behav 18:485–487

    Article  PubMed  Google Scholar 

  15. Janigro D, Iffland PH 2nd, Marchi N, Granata T (2013) A role for inflammation in status epilepticus is revealed by a review of current therapeutic approaches. Epilepsia 54(Suppl 6):30–32

    Article  CAS  PubMed  Google Scholar 

  16. Kossoff EH, Nabbout R (2013) Use of dietary therapy for status epilepticus. J Child Neurol 28:1049–1051

    Article  PubMed  Google Scholar 

  17. Lambrechtsen FA, Buchhalter JR (2008) Aborted and refractory status epilepticus in children: a comparative analysis. Epilepsia 49:615–625

    Article  PubMed  Google Scholar 

  18. Nestler M, Moers A von, Panzer A (2012) Rationale Statustherapie bei Kindern und Jugendlichen – ein QM-Projekt. Monatsschr Kinderheilkd 160(Suppl 1):1–261

    Google Scholar 

  19. Rajasekaran K, Joshi S, Kozhemyakin M et al (2013) Receptor trafficking hypothesis revisited: plasticity of AMPA receptors during established status epilepticus. Epilepsia 54(Suppl 6):14–16

    Article  PubMed  Google Scholar 

  20. Riviello JJ Jr, Ashwal S, Hirtz D et al (2006) 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 67:1542–1550

    Article  PubMed  Google Scholar 

  21. Rosenow F, Hamer HM, Knake S (2013) Therapie des beginnenden und etablierten Status epilepticus. Z Epileptol 26:75–78

    Article  Google Scholar 

  22. Shorvon S (2012) Guidelines for status epilepticus: are we there yet? Neurocrit Care 17:1–2

    Article  PubMed  Google Scholar 

  23. Singh RK, Stephens S, Berl MM et al (2010) Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology 74:636–642

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Steinhoff BJ (2013) Notversorgung durch Laien bei Patienten mit Serien- oder Statusneigung. Z Epileptol 26:223–229

    Article  Google Scholar 

  25. Suleiman J, Brilot F, Lang B et al (2013) Autoimmune epilepsy in children: case series and proposed guidelines for identification. Epilepsia 54:1036–1045

    Article  CAS  PubMed  Google Scholar 

  26. Treiman DM (2008) Importance of early recognition and treatment of generalised convulsive status epilepticus. Lancet Neurol 7:667–668

    Article  PubMed  Google Scholar 

  27. Trinka E (2012) Klinik und Therapie des konvulsiven Status epilepticus. Klin Neurophysiol 43:144–150

    Article  Google Scholar 

  28. Wasterlain CG, Naylor DE, Liu H et al (2013) Trafficking of NMDA receptors during status epilepticus: therapeutic implications. Epilepsia 54(Suppl 6):78–80

    Article  CAS  PubMed  Google Scholar 

  29. Wolff M, Rona S, Krägeloh-Mann I (2011) Therapie des Status epilepticus. Monatsschr Kinderheilkd 159:732–738

    Article  Google Scholar 

  30. Yoong M, Chin RF, Scott RC (2009) Management of convulsive status epilepticus in children. Arch Dis Child Educ Pract Ed 94:1–9

    Article  CAS  PubMed  Google Scholar 

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Danksagung

Der Dank der Autoren gilt der GKinD sowie allen antwortenden Kinderkliniken und -abteilungen.

Einhaltung ethischer Richtlinien

Interessenkonflikt. A. van Baalen: Vortragshonorare und Reisekostenübernahme von ViroPharma GmbH. T. Hoppen, J. Bandowski, A. Rohr geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Neuropädiatrie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 9, 24105, Kiel, Deutschland

    A. van Baalen & J. Bandowski

  2. Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Kemperhof Koblenz, Koblenz, Deutschland

    T. Hoppen

  3. Institut für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    A. Rohr

Authors
  1. A. van Baalen
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  2. T. Hoppen
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  3. J. Bandowski
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  4. A. Rohr
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Corresponding author

Correspondence to A. van Baalen.

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van Baalen, A., Hoppen, T., Bandowski, J. et al. Management des Status epilepticus im Kindesalter. Z. Epileptol. 27, 126–131 (2014). https://doi.org/10.1007/s10309-013-0358-7

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  • DOI: https://doi.org/10.1007/s10309-013-0358-7

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