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[Update on status epilepticus in children. Definition, classification and treatment]
1Universidad Católica de Chile, Hospital Pediátrico Calvo Mackenna, Liga Chilena contra la Epilepsia, Santiago de Chile, Chile.
Insights
Status epilepticus (SE) is a critical neurological emergency in children, defined by prolonged seizures. Prompt treatment initiation, guided by specific timeframes (t1), is crucial to prevent severe outcomes and reduce morbidity.
Area of Science:
- Neurology
- Pediatrics
- Emergency Medicine
Context:
- Status epilepticus (SE) is the most common neurological emergency in pediatric patients.
- SE results from the failure of seizure-terminating mechanisms, leading to prolonged seizures.
- Incidence ranges from 3-42 cases per 100,000 annually, with a bimodal distribution affecting children and the elderly.
Purpose:
- To define status epilepticus (SE) with updated time-sensitive criteria (t1 and t2).
- To emphasize the importance of timely treatment for pediatric SE.
- To highlight the impact of SE on morbidity and mortality.
Summary:
- SE is a prolonged epileptic seizure due to failed termination mechanisms.
- Treatment should commence at specific times (t1): 5 minutes for generalized tonic-clonic seizures, 10 minutes for focal seizures.
- Neuronal damage (t2) is a critical consideration.
Impact:
- Prompt SE treatment reduces risks of cardiac/respiratory complications, ICU admission, and death.
- High morbidity rates (up to 66%) underscore the need for effective interventions.
- Understanding SE's time-dependent nature is vital for improved pediatric neurological care.
Abstract:
Status epilepticus (SE) is the most frequent neurological emergency in neuropediatrics. It is the result of the failure of the mechanisms responsible for terminating an epileptic seizure or its onset, which leads to a prolonged epileptic seizure. The estimated incidence between 3-42 cases per 100,000 people per year. It has a bimodal distribution, affecting children and the elderly at the extremes of life. Mortality estimates are variable depending on age and etiology. Mortality in children could be lower than in adults, but it reaches a high morbidity of up to 66%. The definition has changed over the years in order to specify the start of treatment and to complement it with the scientific data, a time t1 and a t2 have been established. The time (t1) is the moment when treatment should begin, which varies depending on the semiology, at 5 minutes for a generalized tonicclonic seizure and at 10 minutes for a focal seizure. The second time (t2) refers to neuronal damage. Prompt and effective treatment decreases the risks of cardiac and respiratory complications, admission to intensive care units, and death.
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