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Status Epilepticus Australasian Registry for Children: A pilot prospective, observational, cohort study of paediatric
Jeremy S Furyk1,2,3, Shane George4,5,6, Natalie Phillips7
1Emergency Department, The Townsville Hospital, Townsville, Queensland, Australia.
Insights
This study explored paediatric status epilepticus (SE) management in Australia, finding midazolam and levetiracetam are now preferred first and second-line treatments, respectively. The findings support establishing a paediatric SE registry to optimize care.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Clinical Pharmacology
Background:
- Paediatric status epilepticus (SE) can lead to long-term neurological issues.
- Current management strategies for SE in children may have delays.
- Understanding current treatment practices is crucial for improving outcomes.
Purpose of the Study:
- To assess the feasibility of collecting data on paediatric SE cases.
- To describe current pre-hospital and in-hospital management of paediatric SE.
- To identify trends in medication use and patient outcomes.
Main Methods:
- A pilot, prospective, observational cohort study was conducted.
- 167 children aged 4 weeks to 16 years with SE were enrolled across four Australian EDs.
- Data collected included seizure duration, medications administered, and short-term outcomes, with 1-month follow-up.
Main Results:
- Midazolam was the most common first-line agent (87%), with variable dosing.
- Levetiracetam was the preferred second-line agent (60%), used more often than phenytoin or phenobarbitone.
- 62% of patients were admitted to hospital, 8% to ICU, and 4% required intubation.
Conclusions:
- Paediatric SE management in Australia differs from prior reports, favoring midazolam and levetiracetam.
- This pilot study demonstrates the feasibility and utility of a paediatric SE registry.
- Establishing such a registry can aid in understanding and optimizing SE care for children.
Objective:
Paediatric status epilepticus (SE) has potential for long-term sequelae. Existing data demonstrate delays to aspects of care. The objective of the present study was to examine the feasibility of collecting data on children with paediatric SE and describe current management strategies in pre-hospital and in-hospital settings.
Methods:
A pilot, prospective, observational cohort study of children 4 weeks to 16 years of age with SE, in four EDs in Australia. Clinical details including medications administered, duration of seizure and short-term outcomes were collected. Follow up occurred by telephone at 1 month.
Results:
We enrolled 167 children with SE. Mean age was 5.4 years (standard deviation [SD] 4.1), and 81 (49%) male. Median seizure duration was 10 min (interquartile range 7-30). Midazolam was the first medication administered in 87/100 (87%) instances, mean dose of 0.21 mg/kg (SD 0.13). The dose of midazolam was adequate in 30 (35%), high (>0.2 mg/kg) in 44 (51%) and low (<0.1 mg/kg) in 13 (15%). For second-line agents, levetiracetam was administered on 33/55 (60%) occasions, whereas phenytoin and phenobarbitone were administered on 11/55 (20%) occasions each. Mean dose of levetiracetam was 26.4 mg/kg (SD 13.5). One hundred and four (62%) patients were admitted to hospital, with 13 (8%) admitted to ICU and seven (4%) intubated.
Conclusion:
In children presenting with SE in Australia medical management differed from previous reports, with midazolam as the preferred benzodiazepine, and levetiracetam replacing phenytoin as the preferred second-line agent. This pilot study indicates the feasibility of a paediatric SE registry and its utility to understand and optimise practice.
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