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Status epilepticus-Therapeutic management at the pediatric emergency department

I Pais-Cunha1, D Valente1, D B Abreu2

  • 1Serviço de Pediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.

Neurologia
|June 3, 2024
PubMed

Insights

Pediatric status epilepticus management often deviates from guidelines, with infra-therapeutic doses and incorrect drug sequencing linked to prolonged seizures. Adherence to treatment protocols is crucial for better outcomes in pediatric emergencies.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Pharmacology

Background:

  • Status epilepticus is a critical pediatric neurological emergency requiring immediate intervention.
  • Prompt treatment is vital to prevent long-term neurological deficits.
  • Various antiepileptic drugs are available for managing status epilepticus.

Purpose of the Study:

  • To evaluate compliance with established treatment guidelines for pediatric status epilepticus.
  • To identify factors associated with prolonged seizures and unfavorable outcomes.

Main Methods:

  • Retrospective analysis of 117 pediatric status epilepticus admissions over five years (2014-2019).
  • Assessment of drug selection, dosage, and sequencing against treatment protocols.
  • Statistical analysis to correlate treatment deviations with seizure duration and intensive care unit (ICU) admission.

Main Results:

  • Febrile status epilepticus accounted for 23.9% of cases; genetic causes were frequent in non-febrile cases (22.2%).
  • Benzodiazepines were the most common first and second-line treatments (98.2%, 94.8%).
  • Sub-therapeutic doses (48.7%) and incorrect drug sequencing were associated with prolonged seizures and increased antiepileptic drug use.

Conclusions:

  • While benzodiazepines dominate initial treatment, their frequent use as third-line agents, often at sub-therapeutic doses, is notable.
  • Non-adherence to treatment guidelines, including incorrect drug sequencing and dosing, correlates with prolonged status epilepticus and poorer outcomes.
  • Emphasis on guideline adherence is necessary to improve management of pediatric status epilepticus.
Abstract

Keywords:
BenzodiazepinasBenzodiazepinesConvulsionesEstatus epilépticoPediatricsPediatríaSeizureStatus epilepticus

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