[Therapeutic approach to non-convulsive status epilepticus in developmental period]

The episodes of non-convulsive status epilepticus in children are more difficult to discover and to classify than in adult patients. Using ictal clinical and EEG criteria during continous monitoring of 28 patients, aged from 3 to 16 years, 59 episodes of non-convulsive status epilepticus were classified into typical (8), atypical absence status (27) and complex partial status (24). The rational emergent antiepileptic treatment was based on the findings during clinical and EEG monitoring. Whenever necessary, benzodiazepine sensitivity test was applied in order to help the differentiation between absence and complex partial status epilepticus. First-line approach included monotherapy with parenterally applied benzodiazepines. Intravenous (i.v.) diazepam was efficacious in 25 (42.4%), i.m. midazolam in 12 (20.3%), and i.v. clonazepam in 2 episodes of non-convulsive status epilepticus. The use of two drugs (i.v. diazepam initially, followed by i.v. infusion of chlormethiazole, i.m. midazolam and/or i.v. phenytoin) was necessary to stop 13 (22.0%) of status episodes. Besides other factors type of epilepsy and interictal EEG findings during follow-up were suggestive of prognosis in our patients. In one patient with secondary generalized epilepsy 6 of 8 bouts of atypical absence status could not be completely suppressed, in spite of vigourous therapeutic attempts, and her intellectual deterioration resulted. Our results provide further evidence that energic treatment attempts aiming to improve maximally the immediate patients' condition and their EEG findings, as well as to prevent the status recurrence, should be always justified.