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An Italian Survey on the Management of Pediatric Convulsive Status Epilepticus: More Than Just a Pharmacological

Caterina Zanus1, Giulia Cannizzaro2, Giacomo Danieli3

  • 1Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" -, Trieste, Italy.

Brain and Behavior
|April 1, 2025
PubMed

Insights

Pediatric convulsive status epilepticus (CSE) management in Italy shows preference for intravenous midazolam first-line. Treatment variability increases after the first line, influenced by hospital organization and specialist availability.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Critical Care

Background:

  • Pediatric convulsive status epilepticus (CSE) requires prompt and effective management.
  • Guidelines exist, but their real-world application in Italy needs investigation.

Purpose of the Study:

  • To assess Italian specialists' current practices in managing pediatric CSE.
  • To identify factors affecting guideline adherence and treatment choices.

Main Methods:

  • A national web-based survey was distributed to child neurologists, pediatric emergency physicians, and intensivists.
  • The survey included 48 multiple-choice questions on treatment preferences, protocols, and competencies.

Main Results:

  • Intravenous midazolam (iv-MDZ) is the preferred first-line treatment (90% with IV access).
  • Second-line treatment shows significant variability, with phenytoin, levetiracetam, and phenobarbital equally chosen.
  • Organizational factors, such as PICU availability, influence treatment decisions.

Conclusions:

  • First-line pediatric CSE management is standardized with iv-MDZ.
  • Heterogeneity in second-line treatments and organizational factors impact clinical practice.
  • An integrated approach considering setting-specific needs is crucial for optimal CSE management.
Abstract

Keywords:
intensive care unitpediatricstatus epilepticussurveytreatment

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