Timing and selection of first antiseizure medication in patients with pediatric status epilepticus

Area of Science:

• Pediatric Neurology
• Emergency Medicine
• Clinical Pharmacology

Background:

• Pediatric status epilepticus (SE) is a medical emergency associated with significant morbidity.
• Timely and appropriate administration of antiseizure medications (ASM) is critical for managing SE in children.
• Understanding treatment delays and medication selection in the emergency department (ED) setting is essential for improving patient outcomes.

Purpose of the Study:

• To evaluate the timing and selection of antiseizure medications (ASM) in pediatric patients presenting with status epilepticus (SE) to an emergency department (ED).
• To investigate the hypothesis that delays in initial ASM treatment are associated with longer overall SE duration.

Main Methods:

• Retrospective review of medical records for patients diagnosed with SE at a single urban academic pediatric hospital ED between 2009 and 2015.
• Inclusion criteria: physician-documented ICD-9 code for SE.
• Data collected included seizure onset, ASM dosing, route, and timing relative to seizure onset.

Main Results:

• 141 pediatric patients with complete documentation were analyzed.
• Median time to first ASM dose was 25 minutes; 92% received a benzodiazepine (BDZ) as first-line treatment.
• Patients receiving first-dose ASM within 5 minutes had a median SE duration of 59.5 minutes, compared to 151.5 minutes for those receiving it after 60 minutes (p < 0.01).

Conclusions:

• Delays in administering the first dose of ASM were observed in pediatric patients with SE presenting to the ED.
• These delays are associated with prolonged SE duration, supporting the study's hypothesis.
• A subset of prolonged SE cases resolved with a single benzodiazepine dose, indicating that not all prolonged seizures become refractory.