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Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus

Masahiro Nishiyama1, Hiroaki Nagase1, Kazumi Tomioka1

  • 1Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.

Brain & Development
|August 27, 2018
PubMed

Insights

Fosphenytoin (fPHT) and midazolam (cMDL) are comparable second-line treatments for pediatric status epilepticus (SE). Fosphenytoin may be a safer option for patients not requiring barbiturate coma therapy.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Fosphenytoin (fPHT) and continuous intravenous midazolam (cMDL) are common second-line treatments for pediatric status epilepticus (SE) in Japan.
  • No direct comparative studies existed between fPHT and cMDL for pediatric SE.

Purpose of the Study:

  • To compare the efficacy and safety of fPHT versus cMDL as second-line treatments for pediatric convulsive SE.
  • To evaluate the need for barbiturate coma therapy (BCT), recovery of consciousness, and mechanical ventilation in patients treated with fPHT or cMDL.

Main Methods:

  • Retrospective study of pediatric patients admitted to Kobe Children's Hospital with convulsive SE.
  • Patients received either fPHT or cMDL as second-line treatment for SE lasting over 30 minutes.
  • Comparison of BCT rates, consciousness recovery, mechanical ventilation, and inotropic agent use between the two treatment groups.

Main Results:

  • No significant difference in the proportion of patients requiring barbiturate coma therapy (BCT) between fPHT and cMDL groups.
  • After excluding BCT patients, incomplete recovery of consciousness was more frequent with cMDL at 6 and 12 hours post-onset.
  • Mechanical ventilation was required more often in the cMDL group compared to the fPHT group.

Conclusions:

  • Fosphenytoin (fPHT) and midazolam (cMDL) demonstrate similar efficacy in treating pediatric status epilepticus (SE).
  • Continuous intravenous midazolam (cMDL) may reduce the need for barbiturate coma therapy (BCT) compared to fPHT.
  • Fosphenytoin (fPHT) appears to be a relatively safe second-line option for pediatric SE, particularly in patients not requiring BCT.
Abstract

Keywords:
Acute encephalopathyConsciousnessFosphenytoinMidazolamRespiratory depressionSafetySecond-line treatmentStatus epilepticus

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