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Treatment of prolonged convulsive seizures in children; a single centre, retrospective, observational study
Danique R M Vlaskamp1, Oebele F Brouwer1, Petra M C Callenbach1
1Department of Neurology, University Medical Centre of Groningen, Groningen, The Netherlands.
Insights
Rectal diazepam remains a common first-line treatment for prolonged convulsive seizures (PCS) in children, despite evidence favoring buccal midazolam. Clonazepam is also frequently used off-guideline for PCS management.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Pharmacology
Background:
- Prolonged convulsive seizures (PCS) require prompt and effective treatment in children.
- Established treatment guidelines exist for convulsive status epilepticus (CSE), but adherence and real-world practice may vary.
- Understanding current treatment patterns is crucial for optimizing pediatric seizure management.
Purpose of the Study:
- To evaluate the treatment practices for pediatric prolonged convulsive seizures (PCS) at the University Medical Centre Groningen (UMCG).
- To compare current treatment strategies with the 2005 Dutch guideline for CSE.
- To identify trends and deviations in the management of pediatric PCS.
Main Methods:
- Retrospective analysis of a UMCG database of children (<18 years) with epilepsy and their first seizure between 2000-2010.
- Inclusion criteria: PCS lasting ≥10 minutes, occurring between January 2000 and October 2012 in children >1 month.
- Analysis of treatment order, timing, location, and comparison with the 2005 Dutch guideline.
Main Results:
- 269 PCS episodes in 102 children were analyzed; most started outside the hospital and lasted 10-30 minutes.
- Rectal diazepam was the most frequent first-line treatment (59.6% for first PCS, 43.9% for subsequent PCS).
- A trend towards buccal midazolam emerged since 2006; clonazepam was a common second-line choice despite not being guideline-recommended.
Conclusions:
- Rectal diazepam continues to be the primary choice for PCS management in this cohort, despite the superior efficacy of buccal midazolam.
- Clonazepam is frequently utilized as a second-line agent, deviating from formal Dutch treatment recommendations.
- Clinical practice for pediatric PCS may not fully align with established guidelines, highlighting areas for potential educational intervention and guideline reinforcement.
Objectives:
To evaluate treatment of children with Prolonged Convulsive Seizures (PCS) at the University Medical Centre Groningen (UMCG).
Material And Methods:
PCS were identified from an UMCG database of children with epilepsy aged <18 years who had their first (a)febrile seizure between 2000 and 2010. PCS were included if they lasted ≥10 min and occurred between January 2000 and October 2012 in children aged >1 month. Order, timing, and location of treatment were analysed. Treatment of PCS before and after 2005 was compared with recommendations from a Dutch 2005 treatment guideline for Convulsive Status Epilepticus (CSE) in children aged >1 month.
Results:
269 PCS occurring in 102 children were included (53.9% male, median age 2.8 years; range 0.1-13.7 years). Seventy episodes concerned a first PCS. Most first and subsequent PCS started outside the hospital (78.6% and 82.4%, respectively) and lasted 10-30 min (42.4% and 51.4%, respectively). Cessation occurred after two administrations of any therapy in first (median, range 0-7) and subsequent PCS (median, range 0-10). First treatment choice was rectal diazepam in first (59.6%) and subsequent (43.9%) PCS, but since 2006 a trend towards buccal midazolam was observed in subsequent PCS. Clonazepam was frequently used as second treatment choice in first (43.8%) and subsequent (27.3%) PCS, although not mentioned in the guideline.
Conclusion:
In our study cohort rectal diazepam is still first choice in the management of PCS despite proven superior efficacy of buccal midazolam. Clonazepam is frequently used although it is not formally recommended in a Dutch guideline.
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