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Survey of Pediatric Status Epilepticus Treatment Practices and Adherence to Management Guidelines (Pedi-SPECTRUM
Renu Suthar1, Suresh Kumar Angurana2, Karthi Nallasamy2
1Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Insights
This survey reveals common treatments for pediatric status epilepticus in India, noting variations in medication use and guideline adherence for refractory and super-refractory cases.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Epileptology
Background:
- Pediatric status epilepticus (PSE) requires prompt and guideline-adherent management.
- Understanding current treatment practices in India is crucial for improving patient outcomes.
- This study surveys treatment modalities and guideline adherence for PSE in the Indian context.
Observation:
- A survey of 170 Indian healthcare professionals indicated common use of intravenous midazolam and levetiracetam as first- and second-line antiseizure medications (ASMs).
- Significant variations were observed in the choice of ASMs for refractory (RSE) and super-refractory status epilepticus (SRSE), with midazolam infusion, ketamine, and high-dose phenobarbitone frequently employed.
- Ancillary treatments for SRSE included IV pyridoxine, methylprednisolone, and IVIG, while common etiologies were febrile seizures and viral encephalitis.
Findings:
- Intravenous midazolam, levetiracetam, and midazolam infusion are the most frequently used first-, second-, and third-line ASMs, respectively.
- Treatment practices for RSE and SRSE, including ASM selection and ancillary therapies, showed considerable variability among practitioners.
- Adherence to PSE management guidelines regarding the timing of ASM initiation ranged from 63.5% to 88.8%.
Implications:
- Standardization of treatment protocols for RSE and SRSE in India could improve consistency and outcomes.
- Further research into optimal ancillary treatments and guideline implementation strategies for PSE is warranted.
- The findings highlight the need for continued medical education and dissemination of evidence-based guidelines for pediatric status epilepticus management.
Aim:
Survey of treatment practices and adherence to pediatric status epilepticus (PSE) management guidelines in India.
Methods:
This eSurvey was conducted over 35 days (15th October to 20th November 2023) and included questions related to hospital setting; antiseizure medications (ASMs); ancillary treatment; facilities available; etiology; and adherence to PSE management guidelines.
Results:
A total of 170 respondents participated, majority of them were working in tertiary level hospitals (94.1%) as pediatric intensivists (56.5%) and pediatricians (19.4%), and were in clinical practice for 2-10 years (46.5%). Majority use intravenous (IV) midazolam and levetiracetam as first- and second-line ASMs (67.1 and 51.2%, respectively). In cases with refractory status epilepticus (RSE), the most commonly used ASM is midazolam infusion (92.4%). For super-refractory status epilepticus (SRSE), the commonly used third-line ASMs include midazolam infusion (34.1%), thiopentone infusion (26.5%), high dose phenobarbitone (18.2%), and ketamine infusion (15.3%). Overall, in cases with SRSE, 44.7% respondents use ketamine infusion, 42.5% use add-on oral topiramate, and 34.7% use high-dose phenobarbitone (1-3 mg/kg/hour) infusion. Most respondents targeted both clinical and EEG seizure control (48.8%). Ancillary treatment used for SRSE included IV pyridoxine (57.1%), methylprednisolone (45.3%), IVIG (42.4%), ketogenic diet (40.6%), and second-line immunomodulation (33.5%). Most common causes were febrile SE, viral encephalitis, and febrile illness-related epilepsy syndrome (60.6%, 52.4%, and 37.1%, respectively). Facilities available included pediatric intensive care units (PICU) (97.1%), mechanical ventilation (98.2%), pediatric neurologist (68.8%), MRI brain (86.5%), EEG (69.4%), and viral PCR (58.2%). The compliance with guidelines for timing of initiation of ASM ranged from 63.5 to 88.8%.
Conclusion:
Intravenous midazolam bolus/es, levetiracetam, and midazolam infusion are commonly used first-, second-, and third-line ASMs, respectively. There were wide variations in use of ASMs for RSE and SRSE, ancillary treatment, and compliance to PSE management guidelines.
How To Cite This Article:
Suthar R, Angurana SK, Nallasamy K, Bansal A, Muralidharan J. Survey of Pediatric Status Epilepticus Treatment Practices and Adherence to Management Guidelines (Pedi-SPECTRUM e-Survey). Indian J Crit Care Med 2024;28(5):504-510.
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