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[Paediatric status epilepticus]
V Soto-Insuga1, E González-Alguacil1, J J García-Peñas1
1Hospital Infantil Universitario Niño Jesús, 28009 Madrid, España.
Insights
Status epilepticus, a medical emergency where seizures don't stop, requires prompt treatment. Early intervention in children is crucial to prevent mortality and long-term neurological issues.
Area of Science:
- Neurology
- Pediatric Emergency Medicine
Background:
- Status epilepticus is a critical neurological condition arising from failed seizure termination mechanisms.
- International guidelines define critical time points for initiating treatment (5-15 minutes) and indicate high risk of sequelae after 30 minutes for convulsive status.
- Pediatric status epilepticus affects 3-42/100,000 children annually, with 10-40% experiencing refractory or super-refractory seizures.
Purpose of the Study:
- To provide a comprehensive review of therapeutic strategies for status epilepticus.
- To outline treatment options from initial home management to advanced third-line interventions.
- To emphasize the importance of timely diagnosis and treatment in pediatric cases.
Main Methods:
- Review of current therapeutic options for status epilepticus.
- Categorization of treatments into first-line (benzodiazepines), second-line (e.g., phenobarbital, valproic acid), and third-line therapies.
- Inclusion of both pharmacological and non-pharmacological interventions.
Main Results:
- A wide spectrum of treatments is available, ranging from benzodiazepines to anesthetics, ketogenic diets, and epilepsy surgery.
- The article details specific drugs within each treatment line, including newer agents like levetiracetam, lacosamide, brivaracetam, and perampanel.
- Non-pharmacological options such as ketogenic diet, immunomodulatory treatments, and epilepsy surgery are also discussed.
Conclusions:
- Early identification and treatment are paramount to prevent status epilepticus progression and reduce sequelae.
- While less severe than in adults, pediatric status epilepticus carries a mortality risk of 3-5% and a 25% risk of developing subsequent epilepsy.
- A significant percentage of children experience long-term neurological deficits following status epilepticus.
Introduction:
Status epilepticus is defined as the situation resulting from the failure of the mechanisms responsible for terminating an epileptic seizure. In 2015, an operational concept was adopted internationally in which two times are identified: a first time, at which treatment must begin (five minutes for convulsive status, 10-15 minutes for focal and non-convulsive status); and a second time, after which there is considered to be a high risk of subsequent sequelae (30 minutes in the case of the convulsive). It occurs in 3-42/100,000 children per year, who are refractory or super-refractory in 10-40% of cases.
Development:
This article will review the different therapeutic options for status, from early treatment at home to the different first-line (benzodiazepines), second-line (phenobarbital, valproic acid, phenytoin, levetiracetam and lacosamide) or third-line treatments, which include both pharmacological (anaesthetics, propofol, ketamine, lidocaine, topiramate, brivaracetam or perampanel) and non-pharmacological (ketogenic diet, immunomodulatory treatments or epilepsy surgery) therapies.
Conclusions:
Early identification and treatment of a prolonged crisis are essential to prevent progression to status. Although with fewer sequelae than in adults, status epilepticus in children represents a cause of mortality of up to 3-5%, while 25% of them will develop subsequent epilepsy, as well as a considerable percentage of neurological sequelae.
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