Application of high-dose Diazepam in epileptic children with electrical status epilepticus during sleep

Abstract

Objective To explore the therapeutic effects and adverse reaction of high-dose Diazepam (DZP) in patients with electrical status epilepticus during sleep (ESES). Methods Nine patients in the Outpatient of the Department of Pediatrics, Peking University First Hospital from October 2016 to May 2017 with ESES were treated with high-dose DZP.Oral DZP was administered in a dose of 0.75-1.00 mg/kg(maximum: 40 mg) during the first night followed by 0.5 mg/(kg·d) (maximum: 20 mg) from the second night for 1-3 months and tapered over next 1-3 months.The seizures, electroencephalogram (EEG) changes and adverse reactions were observed before and after DZP treatment. Results Six of 9 patients were male and 3 were female.The age of onset was ranged from 1 year and 6 months to 10 years.Benign childhood epilepsy with central temporal spike was diagnosed in 5 cases, epileptic encephalopathy with continuous spike-and-wave during sleep in 1 case, and ESES related epilepsy in 3 cases.Age of onset DZP treatment ranged from 4 years and 4 months to 12 years, and the duration of DZP treatment was ranged from 1 to 5 months (1 case only for the first night). The follow-up interval was 6-12 months.The efficiency of DZP on seizures: intent effective in 5 patients, effective in 2 patients and ineffective in 2 patients, and the effective rate was 78% (7/9 cases). The efficiency of DZP on EEG (1 month after DZP treatment): intent effective in 2 patients (EEG norma-lized), effect in 3 patients and no effect in 2 patients, and the effective rate was 71% (5/7 cases), while 2 patients did not receive EEG examination.Four of 7 patients (57%) with intent effect and effective of DZP on seizures had seizures relapse during drug reduction and after drug withdrawal, and the EEG deteriorated simultaneously.Adverse reactions of DZP included 3 patients (33%) with adverse reactions, bed-wetting in 2 patients and snoring on the first night in 1 patient who withdrew DZP later. Conclusions The high-dose of DZP has a certain effect on seizures control and ESES suppression in patients with ESES, but also has a certain recurrence rate.The adverse reactions are mild and self-limiting.High-dose DZP treatment could be a choice for refractory patients with ESES to alleviate disease. Key words: Electrical status epilepticus during sleep; Diazepam; Epilepsy