Recognition and Treatment of Prolonged Febrile Seizures; Results from the FEBSTAT Study (IN5-2.005)

Abstract

Objective: Analyze pre-hospital and emergency department (ED) recognition of febrile seizures and treatment of febrile status epilepticus (FSE). Background Seizure recognition and prompt treatment is important. Design/Methods: 200 subjects were children 1 month to 5 years who are part of a prospective, multicenter study of consequences of FSE, defined as a febrile seizure or series of seizures lasting >30 minutes. FSE was classified by 3 independent central raters, and based exclusively on clinical features. The emergency medical service (EMS) and ED management, including seizure recognition, medication administration and respiratory support, were reviewed. Results: 46 subjects (23%) did not activate EMS. 154 subjects were transported by EMS, 12 (8%) were not seizing when EMS arrived and 24 (16%) did not have documentation of the patient9s clinical condition. 118 subjects were actively seizing on EMS arrival, 81% (96 subjects) were recognized by EMS. During EMS transport, 9 subjects (6%) were not actively seizing. EMS recognized seizure during transport in 83 patients (54%). Anti-epileptic medications (AED) were given by family/EMS in 73 subjects (37%). 19 of the 154 patients (12%) were given respiratory support by EMS. 167 subjects (84%) were actively seizing on ED arrival. ED recognized the seizure in 163 subjects (98%). 91 of 200 subjects (46%) were given respiratory support by the ED. 150 subjects (75%) required an AED to terminate seizure. Mean time from seizure onset to first AED was 55 minutes (3 minutes to 465 minutes). Conclusions: Febrile status epilepticus is a neurological emergency requiring prompt recognition and treatment. The majority of children with prolonged febrile seizures required abortive medications to terminate their seizures, which were very prolonged. Although the majority of seizures are recognized, there is a considerable delay in administration of first AED. Supported by: Grant NS 43209 (PI: S Shinnar MD PhD) from NINDS. Disclosure: Dr. Seinfeld has nothing to disclose. Dr. Pellock has received personal compensation for activities with NIH/NINDS, Eisai, GSK, King Pharmaceuticals, KV Pharmaceuticals, Marinus Pharmaceuticals, Neuropace, Ortho McNeil Johnson&Johnson, Lundbeck, Pfizer, Questcor, Sepracor, UCB Pharmaceuticals, and Valeant as an advisory board member, consultant, or lecturer. Dr. Pellock has received research support from NIH/NINDS, Eisai, GSK, Lundbeck, Pfizer, Questcor, UCB Pharmaceuticals, and Valeant. Dr. Shinnar has received personal compensation for activities with Design Write, Eisai, Inc., King Pharmaceuticals, Questcor Pharmaceuticals, Valeant Pharmaceuticals, and UCB Pharma. Dr. Shinnar has received research support from Questcor Pharmaceuticals. Dr. Hesdorffer has nothing to disclose. Dr. Shinnar has nothing to disclose. Dr. O9Hara has received personal compensation for activities with Cyberonics and Questcor as a speaker and/or serving on an advisory board. Dr. Nordli has received personal compensation in an editorial capacity for UpToDate. Dr. Nordli has received research support from NIH/NINDS. Dr. Frank has nothing to disclose. Dr. Gallentine has nothing to disclose. Dr. Moshe has received personal compensation for activities with Eisai and GlaxoSmithKline. Dr. Moshe has received personal compensation in an editorial capacity for Neurobiology of Disease, Epileptic Disorders, and Brain and Development and Physiological Research. Dr. Moshe has received research support from NIH and the Heffer Family Foundation. Dr. Deng has nothing to disclose. Dr. Sun has nothing to disclose.