[Refractory convulsive status epilepticus in childhood]

Area of Science:

• Neurology
• Critical Care Medicine

Context:

• Refractory convulsive status epilepticus (RCSE) presents a significant medical emergency.
• RCSE is defined as seizures lasting over an hour, unresponsive to initial anticonvulsant therapies.
• Delayed or inadequate treatment of RCSE escalates mortality and neurological deficits.

Purpose:

• To outline the critical management strategies for RCSE.
• To emphasize the importance of intensive care interventions and etiological diagnosis in RCSE.

Summary:

• First-line treatments include benzodiazepines, phenobarbital, and phenytoin.
• For refractory cases, midazolam infusion and general anesthesia are indicated.
• Intensive care focuses on vital function control, homeostasis, and managing complications.
• Identifying the underlying cause of status epilepticus is crucial for targeted symptomatic therapy.

Impact:

• RCSE carries a substantial mortality rate of 13.5%, significantly higher (28.6%) in acute symptomatic cases.
• Early neurological sequelae affect a considerable portion of patients (40.6%), with higher rates in acute symptomatic groups (70%).