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Management of prolonged seizures and status epilepticus in childhood: a systematic review

Kalliopi Sofou1, Ragnhildur Kristjánsdóttir, Nikolaos E Papachatzakis

  • 1Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden. kalliopi.sofou@vgregion.se

Journal of Child Neurology
|April 1, 2009
PubMed

Insights

Buccal midazolam effectively controls pediatric prolonged seizures, offering a safe first-line treatment. Intranasal lorazepam and intravenous valproate also show promise for seizure management.

Area of Science:

  • Neurology
  • Pediatric Emergency Medicine

Background:

  • Prolonged seizures and status epilepticus in children are critical emergencies.
  • Prompt intervention is vital for life support and seizure control.

Purpose of the Study:

  • To systematically review the management of pediatric prolonged seizures and status epilepticus.
  • To compare the efficacy and safety of various anticonvulsant medications.

Main Methods:

  • Systematic review of published data on seizure management.
  • Analysis of treatment effectiveness, seizure control rates, and recurrence rates.

Main Results:

  • Buccal midazolam demonstrated higher efficacy (70% seizure control) than rectal diazepam.
  • Intranasal lorazepam proved effective, comparable to intramuscular paraldehyde.
  • Intravenous valproate showed faster seizure cessation and a safer profile than intravenous diazepam in refractory status epilepticus.

Conclusions:

  • Buccal midazolam is a safe and effective first-line treatment for prolonged seizures due to its ease of administration.
  • Intranasal lorazepam offers an effective, safe, and user-friendly option for prolonged seizures.
  • Intravenous valproate is a favorable third-line option for refractory status epilepticus, demonstrating good efficacy and safety.

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