Time from convulsive status epilepticus onset to anticonvulsant administration in children

Iván Sánchez Fernández1, Nicholas S Abend1, Satish Agadi1

  • 1From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY.

Neurology
|May 8, 2015
PubMed

Insights

Treatment delays for pediatric convulsive status epilepticus (SE) are significant. Antiepileptic drug (AED) administration, especially escalation to different drug classes, is often delayed in both prehospital and hospital settings.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Clinical Pharmacology

Background:

  • Pediatric convulsive status epilepticus (SE) is a medical emergency requiring prompt treatment.
  • Delays in administering antiepileptic drugs (AEDs) can lead to prolonged seizures and adverse outcomes.
  • Understanding treatment timelines is crucial for optimizing care protocols.

Purpose of the Study:

  • To quantify the time from onset of pediatric convulsive SE to the administration of the first and subsequent AEDs.
  • To analyze the timing of AED administration in relation to SE severity and treatment escalation.
  • To compare prehospital and in-hospital treatment delays.

Main Methods:

  • Prospective observational cohort study of pediatric patients (1 month-21 years) with convulsive SE.
  • Study population restricted to patients requiring multiple AED classes or continuous infusions.
  • Data collected on timing of AED administration from SE onset.

Main Results:

  • Median time to first AED dose was 28 minutes, second at 40 minutes, and third at 59 minutes.
  • First non-benzodiazepine AED dose administered at a median of 69 minutes.
  • In out-of-hospital SE, 62.5% of patients received no AED before hospital arrival; in-hospital, first doses were given at a median of 8 minutes post-onset/arrival.

Conclusions:

  • Significant delays exist in administering AEDs from SE onset in pediatric patients.
  • Escalation to different classes of AEDs is also delayed.
  • Treatment delays occur in both prehospital and in-hospital settings, highlighting a need for improved management strategies.
Abstract

Related Concept Videos

Seizures: Classification01:13

Seizures: Classification

Epilepsy is primarily characterized by unpredictable seizures, either provoked by an identifiable factor, such as injury or illness, or unprovoked, occurring spontaneously without apparent cause.
Seizures are typically classified into two main categories: focal and generalized seizures.
Focal Seizures
Focal seizures originate from specific regions of the brain. These seizures are further sub-classified into two types:
2.3K
Epilepsy and Seizures: Overview01:24

Epilepsy and Seizures: Overview

Epilepsy is a chronic neurological disease marked by recurrent, unpredictable seizures. These seizures are caused by abnormal electrical discharges in the brain, leading to behavior, sensation, or consciousness alterations. They can also cause transient impairment of awareness, interfering with daily activities.
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...
1.7K
Antiepileptic Drugs: Potassium Channel Activators01:20

Antiepileptic Drugs: Potassium Channel Activators

Ezocgabine or retigabine, an antiepileptic drug of remarkable efficacy, has revolutionized the management of seizures. It is a potassium channel activator, explicitly targeting the family of Q subtype potassium channels. It enhances the transmembrane potassium currents, regulating neuronal excitability. This action stabilizes the resting membrane potential, a pivotal factor in mitigating the hyperexcitability that characterizes epilepsy.
Ezogabine has gained approval as an adjunctive treatment...
1.0K
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
389
Antiepileptic Drugs: GABAergic Pathway Potentiators01:18

Antiepileptic Drugs: GABAergic Pathway Potentiators

γ-aminobutyric acid or GABA, plays a pivotal role as an inhibitory neurotransmitter in the brain. GABA pathway potentiators, also known as GABAergic drugs, are a class of pharmaceutical agents designed to enhance the functioning of the GABAergic system. These medications primarily treat epilepsy, a neurological disorder characterized by recurrent seizures.
The key GABA pathway potentiators used in epilepsy management are as follows.
Benzodiazepines are a well-known class of drugs used for...
1.8K
Antiepileptic Drugs: Calcium Channel Blockers01:17

Antiepileptic Drugs: Calcium Channel Blockers

Calcium channel blockers, a class of antiepileptic drugs, regulate the flow of calcium ions within neurons.
Calcium channel blockers exert their antiepileptic effects by targeting T-type calcium channels, which are integral to transmitting nerve signals in the central nervous system. These channels allow the passage of calcium ions, which are vital for neuronal communication. By inhibiting T-type calcium channels, calcium channel blockers effectively reduce the release of neurotransmitters and...
1.7K