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Convulsive status epilepticus in children: etiology, treatment protocol and outcome

Eylem Ulas Saz1, Bulent Karapinar, Mustafa Ozcetin

  • 1Pediatric Emergency Department, Ege University School of Medicine, 35100 Bornova, Izmir, Turkey.

Seizure
|January 4, 2011
PubMed

Insights

This study evaluated a pediatric protocol for convulsive status epilepticus (SE) using diazepam and midazolam. The combined benzodiazepine approach proved safe and effective for treating pediatric SE, including refractory cases.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Clinical Pharmacology

Background:

  • Convulsive status epilepticus (SE) in children requires prompt and effective treatment.
  • Existing treatment protocols vary, necessitating evaluation of standardized approaches.
  • Understanding the etiology and outcomes of pediatric SE is crucial for improving patient care.

Purpose of the Study:

  • To determine the etiology, treatment protocol, and outcomes of convulsive SE in children.
  • To assess the efficacy and safety of an institutional treatment protocol (EPSEP) using benzodiazepines.
  • To categorize pediatric SE based on seizure duration and evaluate treatment responses.

Main Methods:

  • Retrospective case study analyzing pediatric SE episodes.
  • Implementation of the Ege Pediatric Status Epilepticus Protocol (EPSEP) with defined SE categories (initial, established, refractory).
  • Administration of diazepam and midazolam according to the protocol, including bolus and infusion strategies.

Main Results:

  • Meningitis or encephalitis was the etiology in 40% of cases; febrile SE occurred in 26%.
  • Initial SE (20-30 min) had limited success with rectal diazepam alone (7.5%).
  • Midazolam infusion achieved complete cessation of convulsive SE in 95% of 22 treated episodes (including refractory and established SE).

Conclusions:

  • The combined use of diazepam and midazolam is a safe and effective treatment strategy for pediatric convulsive SE.
  • The EPSEP protocol provides a structured approach to managing pediatric SE based on seizure duration.
  • Midazolam infusion is highly effective for established and refractory pediatric SE.

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