[Management of pediatric status epilepticus]

Area of Science:

• Pediatric Neurology
• Emergency Medicine
• Epileptology

Background:

• Pediatric Status Epilepticus (SE) presents a significant risk of morbidity and mortality.
• Current understanding necessitates early and aggressive intervention for improved patient outcomes.
• The definition of SE has evolved, with a reduced time criterion to 5 minutes.

Purpose of the Study:

• To review and update concepts, pathophysiology, and etiology of convulsive SE in pediatrics.
• To provide an overview of available antiepileptic treatments for pediatric SE.
• To propose a rational management scheme for pediatric SE.

Main Methods:

• A comprehensive literature search was conducted for articles published between January 1993 and January 2013.
• The search focused specifically on the pediatric population.
• Evidence synthesis from case series, primarily adult data, was used due to limited pediatric-specific research.

Main Results:

• The definition of SE was updated to a minimum of 5 minutes of continuous or recurrent seizures without consciousness recovery.
• Refractory SE is defined as SE persisting beyond 60-120 minutes, requiring anesthetic management.
• Super-refractory SE involves a lack of response to or relapse during anesthetic withdrawal.
• Reported outcomes include 35% mortality, 26% neurological sequelae, and 35% recovery to baseline.

Conclusions:

• Evidence for pediatric SE management is limited, often extrapolated from adult studies.
• Treatment alternatives like immunotherapy, ketogenic diet, surgery, and hypothermia are discussed.
• A structured management approach is essential for optimizing care in pediatric SE.