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Medical management with diazepam for electrical status epilepticus during slow wave sleep in children
Densley Francois1, Jessica Roberts1, Stephany Hess1
1Upstate Golisano Children's Hospital, Upstate Medical University, Syracuse, NY.
Insights
High-dose oral diazepam effectively reduced electrical status epilepticus during slow wave sleep (ESES) in children, decreasing spike wave counts. However, some patients experienced new behavioral and neurological side effects, warranting further investigation.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Pharmacology
Background:
- Electrical status epilepticus during slow wave sleep (ESES) is a challenging condition in children.
- Oral diazepam is a proposed treatment, but its long-term efficacy and safety require further evaluation.
Purpose of the Study:
- To retrospectively assess the long-term efficacy of high-dose oral diazepam in reducing electrographic and clinical signs of ESES in children.
- To evaluate safety and behavioral outcomes in children receiving ongoing diazepam therapy for ESES.
Main Methods:
- Retrospective analysis of demographic and clinical data from 42 children treated for ESES between 2010 and 2013.
- Assessment of electroencephalograph (EEG) spike wave index reduction (≥50%) after high-dose oral diazepam administration.
- Caregiver questionnaires to evaluate behavioral problems and side effects.
Main Results:
- 69.2% of 26 evaluable children achieved >50% reduction in EEG spike wave count (average reduction from 15.54 to 5.05, P=0.001).
- Caregiver surveys (28 responses) indicated new onset problem-solving, speech, and writing difficulties in some patients.
- Most frequent side effects included sleep disturbances (50%) and irritability (57.1%); no dose-related effects were observed.
Conclusions:
- High-dose oral diazepam significantly reduces EEG spike wave count in pediatric ESES.
- While effective for EEG findings, diazepam therapy may be associated with significant neurological and behavioral side effects.
- Further research is warranted to optimize treatment and manage adverse effects of diazepam in ESES.
Objective:
Oral diazepam, administered in varying doses, is among the few proposed treatment options for electrical status epilepticus during slow wave sleep in children. We sought to retrospectively evaluate the long-term efficacy of high-dose oral diazepam in reducing electrographic and clinical evidence of electrical status epilepticus during slow wave sleep in children. Additionally, we surveyed caregivers to assess safety and behavioral outcomes related to ongoing therapy.
Methods:
We collected demographic and clinical data on children treated for electrical status epilepticus during slow wave sleep between October 2010 and March 2013. We sought to identify the number of patients who achieved at least a 50% reduction in spike wave index on electroencephalograph after receiving high-dose oral diazepam. We also administered a questionnaire to caregivers to assess for behavioral problems and side effects.
Results:
We identified 42 evaluable patients who received high-dose diazepam (range 0.23-2.02 mg/kg per day) to treat electrical status epilepticus during slow wave sleep. Twenty-six patients had spike reduction data and 18/26 (69.2%) children achieved a greater than 50% reduction in spike wave count from an average of 15.54 to 5.05 (P = 0.001). We received 28 responses to the questionnaire. Some patients experienced new onset of difficulties with problem-solving and speech and writing development. Sleep disturbances (50%) and irritability (57.1%) were the most frequent side effects reported. There did not appear to be a dose-related effect with electroencephalograph changes, behavioral effects, or side effects.
Conclusions:
High-dose oral diazepam significantly reduces the spike wave count on electroencephalograph in children with electrical status epilepticus during slow wave sleep. Although this therapy improves electroencephalograph-related findings, it can be associated with concerning neurological and behavioral side effects in some individuals, so further study is warranted.
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