Related Experiment Video
Updated: May 10, 2026
Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note
Published on: June 13, 2016
Efficacy and Safety Study of the Revised Ege Pediatric Status Epilepticus Protocol (r-EPSEP)
Benay Turan1, Seda Kanmaz2, Caner Turan3
1Department of Pediatrics, Ege University Medical Faculty, Izmir, Turkey.
Insights
The revised Ege Pediatric Status Epilepticus Protocol (r-EPSEP) effectively treats pediatric convulsive status epilepticus (CSE). This updated protocol shows high success rates in terminating CSE and achieving favorable neurologic outcomes in children.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Protocol Development
Background:
- Convulsive status epilepticus (CSE) in children requires prompt and effective treatment protocols.
- Existing treatment guidelines may not always achieve rapid seizure termination, necessitating protocol updates.
- The development of benzodiazepine-resistant and refractory CSE poses significant clinical challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of an updated institutional treatment protocol for pediatric convulsive status epilepticus (CSE).
- To assess the success rates of sequential therapy lines within the revised Ege Pediatric Status Epilepticus Protocol (r-EPSEP).
- To determine the rate of favorable neurologic outcomes in children treated with the r-EPSEP.
Main Methods:
- A single-center, retrospective cohort study was conducted.
- The study analyzed data from 293 children treated with the revised Ege Pediatric Status Epilepticus Protocol (r-EPSEP).
- The protocol included tiered therapy lines: first-line (benzodiazepines), second-line (levetiracetam, diphenylhydantoin, valproic acid), and third-line (midazolam, propofol, or thiopental infusions).
Main Results:
- The cumulative success rates for terminating CSE were 55.2% for first-line, 82.9% for second-line, and 96.9% for third-line therapy.
- Benzodiazepine-resistant CSE occurred in 44.7% of cases; the r-EPSEP successfully terminated refractory CSE in 88% of these children.
- A favorable neurologic outcome was observed in 74.7% of children at intensive care unit discharge.
Conclusions:
- The timeline-based r-EPSEP demonstrates considerable success in terminating pediatric convulsive status epilepticus episodes.
- The protocol achieves high success rates at predefined time points for each therapy line.
- The r-EPSEP is associated with a favorable early neurologic outcome in pediatric patients.
Abstract:
PurposeTo assess the efficacy and safety of an updated institutional treatment protocol for convulsive status epilepticus (CSE).MethodsA single-center, retrospective cohort study was designed to investigate the effectiveness of a protocolized approach for the treatment of pediatric convulsive status epilepticus. The revised Ege Pediatric Status Epilepticus Protocol (r-EPSEP) consists of first-line therapy (step 1 and step 2 with benzodiazepines), second-line therapy (step 3 and 4 with levetiracetam /diphenylhydantoin / valproic acid), and third-line therapy (step 5 with midazolam infusion, and step 6 with propofol or thiopental sodium infusion). The success rates of each therapy line of the r-EPSEP were defined with clinical termination of convulsive status epilepticus.ResultsThe convulsive status epilepticus cohort consisted of 293 children treated with the r-EPSEP. The cumulative success rates of each therapy line were as follows; first-line with 55.2%, second-line with 82.9%, and third-line with 96.9%. Benzodiazepine-resistant convulsive status epilepticus was defined in 131 children (44.7%) with convulsive status epilepticus. The r-EPSEP provided successful termination of refractory convulsive status epilepticus in 66 of 75 children (88%) with 3 therapy categorizations: (1) second-line therapy in 29 patients (38.6%), (2) midazolam infusion in 31 (41.3%), and (3) propofol or thiopental infusion in 6 (8%). Super-refractory convulsive status epilepticus evolved in 9 children (12%). A favorable neurologic outcome was defined in 74.7% of children with Modified Rankin Scores at the discharge time of children from the intensive care unit.ConclusionThe timeline-based protocol (r-EPSEP) provided considerable success rates in terminating status epilepticus episodes at predefined time points of each therapy line with a favorable early neurologic outcome.
