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Childhood convulsive status epilepticus: epidemiology, management and outcome

B G R Neville1, R F M Chin, R C Scott

  • 1Neurosciences Unit, University College, Institute of Child Health, and Great Ormond Street Hospital for Children, NHS Trust, London, UK. b.neville@ich.ucl.ac.uk

Acta Neurologica Scandinavica. Supplementum
|September 6, 2007
PubMed

Insights

Childhood convulsive status epilepticus (CSE) requires prompt treatment. Intravenous lorazepam and phenytoin show promise as first and second-line treatments, respectively, improving outcomes for this pediatric emergency.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Epileptology

Background:

  • Childhood convulsive status epilepticus (CSE) is a distinct medical emergency from adult CSE.
  • Incidence is 17-23/100,000 in developed countries, higher in younger children.
  • Febrile CSE has a good prognosis, unlike CSE from central nervous system infections with high mortality.

Purpose of the Study:

  • To review the epidemiology and treatment of childhood CSE.
  • To compare the efficacy of different first- and second-line treatments.
  • To support the development of prehospital treatment strategies.

Main Methods:

  • Review of epidemiological data and treatment studies for childhood CSE.
  • Comparison of intravenous lorazepam vs. rectal diazepam for first-line treatment.
  • Evaluation of intravenous phenytoin vs. rectal paraldehyde for second-line treatment.

Main Results:

  • Intravenous lorazepam may be superior to rectal diazepam as first-line treatment.
  • Intravenous phenytoin may be superior to rectal paraldehyde as second-line treatment.
  • Prehospital treatment with buccal midazolam is increasingly used, despite being unlicensed.

Conclusions:

  • Early intervention (by 5 min) is crucial for childhood CSE.
  • Treatment guidelines should differentiate between causes and recommend specific drug classes.
  • Further research into prehospital and optimal in-hospital management is warranted.

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