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Pediatric intensive care treatment of uncontrolled status epilepticus

Ryan Wilkes1, Robert C Tasker

  • 1Division of Critical Care, Department of Anesthesia, Pain and Perioperative Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.

Critical Care Clinics
|March 30, 2013
PubMed

Insights

Pediatric refractory status epilepticus in ventilated children lacks treatment guidelines. This review examines second-tier anti-epileptic drugs and anesthetic agents for difficult-to-treat seizures.

Area of Science:

  • Pediatric Neurocritical Care
  • Epileptology
  • Anesthesiology

Background:

  • Critically ill, mechanically ventilated children with refractory seizures pose significant neurocritical care challenges.
  • Limited randomized controlled trial data exists for optimal anti-epileptic drug (AED) strategies in this population.
  • Status epilepticus (SE) management requires effective interventions when initial treatments fail.

Purpose of the Study:

  • To review current pediatric case series on refractory and super-refractory status epilepticus (SE).
  • To summarize definitions and second-tier AED therapies for pediatric SE.
  • To explore the use of high-dose midazolam, barbiturate anesthesia, and volatile anesthetics in uncontrolled pediatric SE.

Main Methods:

  • Literature review of pediatric case series focusing on refractory and super-refractory SE.
  • Analysis of reported definitions and treatment strategies for SE in critically ill children.
  • Examination of outcomes associated with various second-tier AEDs and anesthetic agents.

Main Results:

  • Definitions for refractory and super-refractory SE in pediatric populations are evolving.
  • Second-tier AEDs and anesthetic agents are utilized with varying success in refractory pediatric SE.
  • High-dose midazolam, barbiturate anesthesia, and volatile anesthetics represent advanced options for intractable SE.

Conclusions:

  • Effective management of refractory and super-refractory SE in pediatric neurocritical care remains challenging.
  • Further research is needed to establish evidence-based guidelines for second-tier treatments in pediatric SE.
  • Anesthetic agents are crucial for managing severe, treatment-resistant seizures in critically ill children.

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