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Pediatric status epilepticus: improved management with new drug therapies?
Alberto Verrotti1, Michela Ambrosi1, Piero Pavone2
1a Department of Pediatrics, San Salvatore Hospital , University of L'Aquila , L'Aquila, Italy.
Insights
Prompt treatment of pediatric status epilepticus (SE) is crucial. This review details effective anti-seizure medications for early, established, and refractory SE in children, offering management guidance.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Pharmacology
Background:
- Status Epilepticus (SE) is a common pediatric neurological emergency.
- Effective management requires timely administration of specific anti-seizure medications.
- Current treatment strategies distinguish between emergent and established drug options.
Purpose of the Study:
- To review pharmacological treatment options for pediatric SE.
- To discuss the clinical utility of various anti-seizure drugs in children.
- To propose an algorithm for managing pediatric SE.
Main Methods:
- A comprehensive literature search was conducted using PubMed, Medline, and Embase.
- The review focuses on established and emergent anti-seizure drugs.
- Expert opinion is incorporated for treatment recommendations.
Main Results:
- In early pediatric SE, rectal diazepam or buccal midazolam are effective prehospital treatments; intravenous lorazepam or diazepam are indicated in hospitals.
- For established SE, established drugs like phenytoin and phenobarbital, along with valproic acid, levetiracetam, and lacosamide, are effective.
- Treatment for refractory SE relies on limited data from case series, with midazolam, propofol, ketamine, and lidocaine showing potential but requiring further study.
Conclusions:
- Effective management of pediatric SE involves a stepwise approach using appropriate anti-seizure medications.
- While established treatments exist, further research is needed for refractory SE.
- A proposed algorithm aids in the clinical management of pediatric SE.
Introduction:
Status Epilepticus (SE) is the most common neurological emergency of childhood. It requires prompt administration of appropriately selected anti-seizure medications. Areas covered: Following a distinction between estabilished and emergent drugs, we present pharmacological treatment options and their clinical utility in children, with a short mention on alternatives to drug treatment. We also propose an algorithm for the management of pediatric SE. For this review a Pubmed, Medline and Embase search was performed. Expert opinion: In early SE in children, in the prehospital setting, rectal diazepam or buccal midazolam are efficacious drugs; whereas in the hospital setting, intravenous lorazepam or diazepam are indicated. As regard estabilished stage of SE, in addition to the 'classic' compounds, such as phenytoin and phenobarbital, other drugs such as valproic acid, levetiracetam and lacosamide have been demonstrated efficacious. Treatment recommendations of refractory SE depend on retrospective case series and uncontrolled studies. We reported experiences about the use of midazolam, propofol, ketamine and lidocaine. They could be a valid option, but further prospective studies are necessary. Over the last few decades, important advances in basic mechanisms underlying refractory SE have been achieved, but few data are available regarding management of these stages.
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