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Efficacy of intravenous clonazepam for paediatric convulsive status epilepticus

Maxime Colmard1, François Rivier1,2, Gaëlle de Barry3

  • 1Département de Neuropédiatrie, CHU de Montpellier, Montpellier, France.

Developmental Medicine and Child Neurology
|January 24, 2024
PubMed

Insights

This study found no significant difference in seizure cessation rates for children with convulsive status epilepticus (CSE) treated with different initial doses of intravenous clonazepam (CLZ). However, lower CLZ doses required a second dose more often.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine

Background:

  • Convulsive status epilepticus (CSE) is a medical emergency in children.
  • Intravenous benzodiazepines, such as clonazepam (CLZ), are a first-line treatment for CSE.
  • Optimal dosing strategies for CLZ in pediatric CSE require further investigation.

Purpose of the Study:

  • To compare the efficacy of intravenous clonazepam (CLZ) for the initial management of convulsive status epilepticus (CSE) in children.
  • To evaluate the impact of the first-line in-hospital dose of CLZ on seizure cessation rates and the need for additional doses.

Main Methods:

  • A monocentric retrospective study was conducted at Montpellier University Hospital.
  • Included were children treated with CLZ for CSE between January 2016 and June 2019.
  • Data on clinical presentation, treatment, and outcomes were analyzed based on the initial CLZ dose received.

Main Results:

  • Among 105 children receiving CLZ for CSE, 24 received a low dose (<0.03 mg/kg) and 69 received a high dose (≥0.03 mg/kg).
  • Seizure cessation rates did not differ significantly between low-dose (62.5%) and high-dose (76%) groups (p=0.29).
  • A second dose of CLZ was significantly more frequent in the low-dose group (37.5% vs 16%, p=0.04).

Conclusions:

  • The initial dose of intravenous clonazepam did not significantly impact seizure termination rates in pediatric CSE.
  • Lower initial doses of CLZ (<0.03 mg/kg) were associated with a higher likelihood of requiring a second dose.
  • These findings suggest that while initial efficacy may be similar, dose selection could influence treatment duration and need for subsequent interventions.
Abstract

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