Management of Children with Status Epilepticus

Jo M Wilmshurst

doi:10.17724/jicna.2015.104

Abstract

Status epilepticus is defined as generalised convulsions lasting 30 minutes or longer, which are either continuous, or where there is failure regain consciousness between seizures. The longer the time taken to gain control of seizures the worse the neurological outcome for the child and the harder it is to terminate the seizures. The outcome is further influenced by the underlying aetiology. Treatment of status epilepticus consists of four stages - pre-hospital treatment, emergency department, in-hospital treatment (ward or high care) and anaesthesia (ICU). There are numerous protocols available world-wide. Most are based on the available facilities and the anecdotal preferences of the units involved. Beyond the first level of intervention there are no large evidence based guidelines which identify the optimal intervention. Newer agents are increasingly being used, but studies to assess the true efficacy of these are not available. Further, protocols differ between resource poor countries compared to equipped countries where the capacity to provide intensive care support and expensive medical interventions is limited. There are two targets in the management of status epilepticus namely the rapid identification of the underlying aetiology as this affects treatment and prognosis and the early initiation towards terminating status epilepticus which decreases morbidity and mortality.

Highlights

Status epilepticus is defined as generalised convulsions lasting 30 minutes or longer that are continuous or where there is failure to regain consciousness between seizures
The outcome is further influenced by the underlying aetiology
Treatment of status epilepticus consists of four stages: pre-hospital treatment, emergency department, in-hospital treatment, and anaesthesia (ICU)

Summary

INTRODUCTION

Status epilepticus is defined as generalised convulsions lasting 30 minutes or longer that are continuous or where there is failure to regain consciousness between seizures. This recommendation is not evidence based but is the most effective regimen to follow for the facilities available to manage these children where intensive care beds are lacking. Phenytoin is administered over 30 minutes through a large vein, but not a central line, using a syringe driver and requires cardiac monitoring for potential cardiac toxicity It can only be given by intravenous route (in a solution not mixed with dextrose), cannot be repeated, and is not as effective as phenobarbitone [24]. There is the potential for children to be left with prolonged seizures and irreversible neuronal cell death in centres without high care facilities This intervention is not part of the internationally accepted Advanced Paediatric Life Support (APLS) guidelines [22].

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Findings

SUMMARY AND FUTURE OPTIONS