Skip to main content

Advertisement

Log in

Convulsive and nonconvulsive status epilepticus in children

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Status epilepticus (SE) is a common pediatric neurologic emergency that requires rapid assessment and management. Treatment of pediatric SE involves two equally important factors. First, rapid identification of the underlying etiology is essential, as decisions on how to treat and prognosticate depend on the cause of SE. Second, the timing of treatment initiation with adequate doses is crucial, as early action is most effective in terminating SE and decreasing morbidity and mortality. Currently, early treatment with adequate doses of a benzodiazepine is appropriate, followed by treatment with phenytoin, phenobarbital, or valproic acid. If the seizure does not stop or repetitive seizures continue, the addition of other medications (eg, levetiracetam) or pharmacologic coma induction may be indicated. This review evaluates treatment protocols for acute SE, prolonged SE, and nonconvulsive SE, including some management strategies that use newer anticonvulsants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. 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.

    Article  PubMed  Google Scholar 

  2. Raspall-Chaure M, Chin RF, Neville BG, et al.: Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol 2006, 5:769–779.

    Article  PubMed  Google Scholar 

  3. Arzimanoglou A: Outcome of status epilepticus in children. Epilepsia 2007, 48(Suppl 8):91–93.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  5. Young GB, Jordan KG, Doig GS: An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 1996, 47:83–89.

    PubMed  CAS  Google Scholar 

  6. Abend NS, Dlugos DJ: Nonconvulsive status epilepticus in a pediatric intensive care unit. Pediatr Neurol 2007, 37:165–170.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. Lewena S, Young S: When benzodiazepines fail: How effective is second line therapy for status epilepticus in children? Emerg Med Australas 2006, 18:45–50.

    Article  PubMed  Google Scholar 

  9. Glauser TA: Designing practical evidence-based treatment plans for children with prolonged seizures and status epilepticus. J Child Neurol 2007, 22(5 Suppl):38S–46S.

    Article  PubMed  Google Scholar 

  10. Shah I, Deshmukh CT: Intramuscular midazolam vs intravenous diazepam for acute seizures. Indian J Pediatr 2005, 72:667–670.

    Article  PubMed  Google Scholar 

  11. 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:c58–c64.

    Article  Google Scholar 

  12. Holsti M, Sill BL, Firth SD, et al.: Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatr Emerg Care 2007, 23:148–153.

    Article  PubMed  Google Scholar 

  13. O’Dell C, Shinnar S, Ballaban-Gil KR, et al.: Rectal diazepam gel in the home management of seizures in children. Pediatr Neurol 2005, 33:166–172.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Yu KT, Mills S, Thompson N, et al.: Safety and efficacy of intravenous valproate in pediatric status epilepticus and acute repetitive seizures. Epilepsia 2003, 44:724–726.

    Article  PubMed  CAS  Google Scholar 

  16. 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, 22:1191–1197.

    Article  PubMed  Google Scholar 

  17. Uberall MA, Trollmann R, Wunsiedler U, et al.: Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology 2000, 54:2188–2189.

    PubMed  CAS  Google Scholar 

  18. Taylor LM, Farzam F, Cook AM, et al.: Clinical utility of a continuous intravenous infusion of valproic acid in pediatric patients. Pharmacotherapy 2007, 27:519–525.

    Article  PubMed  CAS  Google Scholar 

  19. Morton LD, O’Hara KA, Coots BP, et al.: Safety of rapid intravenous valproate infusion in pediatric patients. Pediatr Neurol 2007, 36:81–83.

    Article  PubMed  Google Scholar 

  20. Abend NS, Monk HM, Licht DJ, Dlugos DJ: Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med 2009 Mar 25 (Epub ahead of print).

  21. Gallentine WB, Hunnicutt AS, Husain AM: Levetiracetam in children with refractory status epilepticus. Epilepsy Behav 2009, 14:215–218.

    Article  PubMed  Google Scholar 

  22. Lin JJ, Lin KL, Wang HS, et al.: Analysis of status epilepticus related presumed encephalitis in children. Eur J Paediatr Neurol 2008, 12:32–37.

    PubMed  Google Scholar 

  23. Abend NS, Dlugos DJ: Treatment of refractory status epilepticus: literature review and a proposed protocol. Pediatr Neurol 2008, 38:377–390.

    Article  PubMed  Google Scholar 

  24. Jacob TC, Moss SJ, and Jurd R: GABA(A) receptor trafficking and its role in the dynamic modulation of neuronal inhibition. Nat Rev Neurosci 2008, 9:331–343.

    Article  PubMed  CAS  Google Scholar 

  25. Goodkin HP, Joshi S, Mtchedlishvili Z, et al.: Subunit-specific trafficking of GABA(A) receptors during status epilepticus. J Neurosci 2008, 28:2527–2538.

    Article  PubMed  CAS  Google Scholar 

  26. Hayashi K, Osawa M, Aihara M, et al.: Efficacy of intravenous midazolam for status epilepticus in childhood. Pediatr Neurol 2007, 36:366–372.

    Article  PubMed  Google Scholar 

  27. Morrison G, Gibbons E, Whitehouse WP: High-dose midazolam therapy for refractory status epilepticus in children. Intensive Care Med 2006, 32:2070–2076.

    Article  PubMed  CAS  Google Scholar 

  28. Kim SJ, Lee DY, Kim JS: Neurologic outcomes of pediatric epileptic patients with pentobarbital coma. Pediatr Neurol 2001, 25:217–220.

    Article  PubMed  CAS  Google Scholar 

  29. Mirsattari SM, Sharpe MD, Young GB: Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 2004, 61:1254–1259.

    Article  PubMed  Google Scholar 

  30. Lee WK, Liu KT, Young BW: Very-high-dose phenobarbital for childhood refractory status epilepticus. Pediatr Neurol 2006, 34:63–65.

    Article  PubMed  Google Scholar 

  31. Tiamkao S, Mayurasakorn N, Suko P, et al.: Very high dose phenobarbital for refractory status epilepticus. J Med Assoc Thai 2007, 90:2597–2600.

    PubMed  Google Scholar 

  32. Kahriman M, Minecan D, Kutluay E, et al.: Efficacy of topiramate in children with refractory status epilepticus. Epilepsia 2003, 44:1353–1356.

    Article  PubMed  CAS  Google Scholar 

  33. Perry MS, Holt PJ, Sladky JT: Topiramate loading for refractory status epilepticus in children. Epilepsia 2006, 47:1070–1071.

    Article  PubMed  Google Scholar 

  34. Blumkin L, Lerman-Sagie T, Houri T, et al.: Pediatric refractory partial status epilepticus responsive to topiramate. J Child Neurol 2005, 20:239–241.

    PubMed  Google Scholar 

  35. 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 2008 Nov 5 (Epub ahead of print).

  36. Borris DJ, Bertram EH, Kapur J: Ketamine controls prolonged status epilepticus. Epilepsy Res 2000, 42:117–122.

    Article  PubMed  CAS  Google Scholar 

  37. Mewasingh LD, Sekhara T, Aeby A, et al.: Oral ketamine in paediatric non-convulsive status epilepticus. Seizure 2003, 12:483–489.

    Article  PubMed  CAS  Google Scholar 

  38. Ben Yehuda Y, Watemberg N: Ketamine increases opening cerebrospinal pressure in children undergoing lumbar puncture. J Child Neurol 2006, 21:441–443.

    PubMed  Google Scholar 

  39. Himmelseher S, Durieux ME: Revising a dogma: ketamine for patients with neurological injury? Anesth Analg 2005, 101:524–534.

    Article  PubMed  CAS  Google Scholar 

  40. Hamano S, Sugiyama N, Yamashita S, et al.: Intravenous lidocaine for status epilepticus during childhood. Dev Med Child Neurol 2006, 48:220–222.

    Article  PubMed  Google Scholar 

  41. Yildiz B, Citak A, Ucsel R, et al.: Lidocaine treatment in pediatric convulsive status epilepticus. Pediatr Int 2008, 50:35–39.

    Article  PubMed  CAS  Google Scholar 

  42. Hattori H, Yamano T, Hayashi K, et al.: Effectiveness of lidocaine infusion for status epilepticus in childhood: a retrospective multi-institutional study in Japan. Brain Dev 2008, 30:504–512.

    Article  PubMed  Google Scholar 

  43. Yamamoto H, Aihara M, Niijima S, et al.: Treatments with midazolam and lidocaine for status epilepticus in neonates. Brain Dev 2007, 29:559–564.

    Article  PubMed  Google Scholar 

  44. Corry JJ, Dhar R, Murphy T, et al.: Hypothermia for refractory status epilepticus. Neurocrit Care 2008, 9:189–197.

    Article  PubMed  CAS  Google Scholar 

  45. Schrader DV, Steinbok P, Connolly M: Urgent, resective surgery for medically refractory, convulsive status epilepticus. Eur J Paediatr Neurol 2009, 13:10–17.

    Article  PubMed  Google Scholar 

  46. 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.

    PubMed  CAS  Google Scholar 

  47. Tay SK, Hirsch LJ, Leary L, et al.: Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia 2006, 47:1504–1509.

    Article  PubMed  Google Scholar 

  48. Jette N, Claassen J, Emerson RG, et al.: Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 2006, 63:1750–1755.

    Article  PubMed  Google Scholar 

  49. O’Regan ME, Brown JK: Serum neuron specific enolase: a marker for neuronal dysfunction in children with continuous EEG epileptiform activity. Eur J Paediatr Neurol 1998, 2:193–197.

    Article  PubMed  Google Scholar 

  50. Vespa PM, Miller C, McArthur D, et al.: Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 2007, 35:2830–2836.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eric Marsh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abend, N.S., Marsh, E. Convulsive and nonconvulsive status epilepticus in children. Curr Treat Options Neurol 11, 262–272 (2009). https://doi.org/10.1007/s11940-009-0030-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-009-0030-8

Keywords

Navigation