Status Epilepticus In Children Research Articles

Midazolam Versus Ketamine as the First-line Continuous Infusion for Status Epilepticus in Children with Congenital Heart Disease (S37.005)

Midazolam Versus Ketamine as the First-line Continuous Infusion for Status Epilepticus in Children with Congenital Heart Disease (S37.005)

Clinical profile, etiological factors and outcome of children with status epilepticus admitted in tertiary hospital: a prospective study

Background: Status epilepticus (SE) is a medical emergency, and its neurological outcome is a concern to every pediatrician in developing countries. The incidence of convulsive SE in children is approximately 10–27/100,000 per year, with the highest incidence in children less than one year of age. Approximately 30% of patients presenting with status epilepticus are having their first seizure. The objective of the study is to evaluate the clinical and etiological pattern of SE and its outcome in children admitted to PICU. Methods: This was a prospective study conducted among 50 patients aged 1 month to 12 years presenting with status epilepticus. The study was conducted over a period of one year from April 2022 to April 2023. Results: A majority of the patients were in the age group of 1-5 years (64%) and higher incidence of male children was observed (74%). Generalized tonic clonic seizure (GTCS) was predominant in 76% of the children and seizure duration was 10-20 minutes in 44% of the children. The most common etiologies were Meningoencephalitis (44%) and febrile seizures (20%). Nearly 70% of the children showed complete recovery with no neurological symptoms and 5 (10%) children died. Conclusions: Status epilepticus is a life-threatening emergency and timely management is essential to prevent morbidity and mortality. CNS infection is a major etiology and majority of the children showed good response with AED treatment.  

Using scalp EEG to predict seizure recurrence and electrical status epilepticus in children with idiopathic focal epilepsy

PurposeSome individuals with idiopathic focal epilepsy (IFE) experience recurring seizures accompanied by the evolution of electrical status epilepticus during sleep (ESES). Here, we aimed to develop a predictor for the early detection of seizure recurrence with ESES in children with IFE using resting state electroencephalogram (EEG) data. MethodsThe study group included 15 IFE patients who developed seizure recurrence with ESES. There were 17 children in the control group who did not experience seizure recurrence with ESES during at least 2-year follow-up. We used the degree value of the partial directed coherence (PDC) from the EEG data to predict seizure recurrence with ESES via 6 machine learning (ML) algorithms. ResultsAmong the models, the Xgboost Classifier (XGBC) model achieved the highest specificity of 0.90, and a remarkable sensitivity and accuracy of 0.80 and 0.85, respectively. The CATC showed balanced performance with a specificity of 0.85, sensitivity of 0.73, and an accuracy of 0.80, with an AUC equal to 0.78. For both of these models, F4, Fz and T4 were the overlaps of the top 4 features. ConclusionsConsidering its high classification accuracy, the XGBC model is an effective and quantitative tool for predicting seizure recurrence with ESES evolution in IFE patients. We developed an ML-based tool for predicting the development of IFE using resting state EEG data. This could facilitate the diagnosis and treatment of patients with IFE.

Fenfluramine for the treatment of status epilepticus: use in an adult with Lennox–Gastaut syndrome and literature review

BackgroundNovel treatments are needed to control refractory status epilepticus (SE). This study aimed to assess the potential effectiveness of fenfluramine (FFA) as an acute treatment option for SE. We present a summary of clinical cases where oral FFA was used in SE.MethodsA case of an adult patient with Lennox–Gastaut syndrome (LGS) who was treated with FFA due to refractory SE is presented in detail. To identify studies that evaluated the use of FFA in SE, we performed a systematic literature search.ResultsFour case reports on the acute treatment with FFA of SE in children and adults with Dravet syndrome (DS) and LGS were available. We report in detail a 30-year-old woman with LGS of structural etiology, who presented with generalized tonic and dialeptic seizures manifesting at high frequencies without a return to clinical baseline constituting the diagnosis of SE. Treatment with anti-seizure medications up to lacosamide 600 mg/d, brivaracetam 300 mg/d, valproate 1,600 mg/d, and various benzodiazepines did not resolve the SE. Due to ongoing refractory SE and following an unremarkable echocardiography, treatment was initiated with FFA, with an initial dose of 10 mg/d (0.22 mg/kg body weight [bw]) and fast up-titration to 26 mg/d (0.58 mg/kg bw) within 10 days. Subsequently, the patient experienced a resolution of SE within 4 days, accompanied by a notable improvement in clinical presentation and regaining her mobility, walking with the assistance of physiotherapists. In the three cases reported in the literature, DS patients with SE were treated with FFA, and a cessation of SE was observed within a few days. No treatment-emergent adverse events were observed during FFA treatment in any of the four cases.ConclusionsBased on the reported cases, FFA might be a promising option for the acute treatment of SE in patients with DS and LGS. Observational data show a decreased SE frequency while on FFA, suggesting a potentially preventive role of FFA in these populations.Key pointsWe summarize four cases of refractory status epilepticus (SE) successfully treated with fenfluramine.Refractory SE resolved after 4–7 days on fenfluramine.Swift fenfluramine up-titration was well-tolerated during SE treatment.Treatment-emergent adverse events on fenfluramine were not observed.Fenfluramine might be a valuable acute treatment option for SE in Dravet and Lennox–Gastaut syndromes.

Natural Language Processing for Identification of Refractory Status Epilepticus in Children.

Pediatric status epilepticus is one of the most frequent pediatric emergencies, with high mortality and morbidity. Utilizing electronic health records (EHR) permits analysis of care approaches and disease outcomes at a lower cost than prospective research. However, reviewing EHR manually is time intensive. We aimed to compare refractory status epilepticus (rSE) cases identified by human EHR review with a Natural language processing (NLP)-assisted rSE screen followed by a manual review. We used the NLP screening tool, Document Review Tool (DrT), to generate regular expressions, trained a bag-of-words NLP classifier on EHR from 2017-2019, and then tested our algorithm on data from February to December 2012. We compared results from manual review to NLP-assisted search followed by manual review. Our algorithm identified 1528 notes in the test set. After removing notes pertaining to the same event by DrT, the user reviewed a total number of 400 notes to find patients with rSE. Within these 400 notes, we identified 31 rSE cases, including 12 new cases not found in manual review, and 19 of the 20 previously identified cases. The NLP-assisted model found 31/32 cases with a sensitivity of 96.88% (95% C.I. 82-99.84%), while manual review identified 20/32 cases, with a sensitivity of 62.5% (95% C.I. 43.75-78.34%). DrT provided a highly sensitive model compared to human review and an increase in patient identification through EHRs. The use of DrT is a suitable application of NLP for identifying patients with a history of recent rSE which ultimately contributes to the implementation of monitoring techniques and treatments in near real-time.

The etiologies and outcome of convulsive status epilepticus in children at tertiary care hospital Kashmir India

Background: Convulsive status epilepticus (CSE) is a common neurological emergency, where immediate supportive and specific treatment determines the outcome of the patient. Therefore, immediate management and etiological workup of CSE should be done in tandem to decrease associated morbidity and mortality. Aims and Objectives: The study aimed to ascertain different etiologies and outcomes of CSE in children. Materials and Methods: The study was a prospective observational hospital-based study conducted in a tertiary care hospital from October 2020 to September 2022. Results: The most common type of seizure in CSE was GTCS, 154 cases (83.7%), followed by focal seizure 12 % (26 cases). Almost 35% of patients had CSE as a first presentation for PICU admission and the rest 65% of patients did have a previous history of seizures. The most common etiology of CSE was remote symptomatic, seen in 27.2%, followed by acute central nervous system infection in 19.5%, febrile status in 19.5%, and cryptogenic/idiopathic SD in 14.9%. Among the patients who had encephalitis, the common etiologies were enteroviruses and herpes simplex. We did not find any case of Japanese encephalitis, West Nile encephalitis, cerebral malaria, or dengue case in our study. Therefore, recommending cerebrospinal fluid panels for these vectors borne viral brain diseases is a waste of resources in Kashmir, India. Furthermore, we did not find any case of neurocysticercosis in our study as a cause of CSE. Conclusion: In our study, we had 16 cases of encephalitis, and most of them were caused by enteroviruses and herpes simplex virus. We did not find any case of Japanese encephalitis, West Nile encephalitis, cerebral malaria, or dengue case in our study. Vector-borne diseases transmitted by different mosquitoes do not occur in Kashmir.

WITHDRAWN: Low frequency of non-convulsive status epilepticus in children: myth or reality?

WITHDRAWN: Low frequency of non-convulsive status epilepticus in children: myth or reality?

Status Epilepticus in Children: Experience in a Portuguese Tertiary Hospital

Purpose: Status epilepticus (SE) is a life-threatening neurological emergency, frequently diagnosed in pediatric patients. We aimed to characterize our pediatric cases of SE in an 11-year period according to the 2015 International League Against Epilepsy report. Methods: Clinical electronic records were retrospectively reviewed. All pediatric SE cases admitted from January 2010 to December 2020 were included, excluding neonates. SE was considered refractory if it persisted despite the administration of two appropriate antiseizure medications at acceptable doses.Results: We included 102 episodes, 55 (53.9%) in boys. The median age was 2.5 years (interquartile range, 1.3 to 5.0). Most episodes were classified as SE with prominent motor features (92.2%), and the most frequent etiological classification was acute symptomatic cause (84.3%). A benzodiazepine was used as the first-line antiseizure medication in 99 (97%) cases, of which diazepam was preferred (93%). The preferred second-line medication was phenytoin (65.7%). Midazolam was the most frequently responsible for termination of SE when given in a continuous infusion (47%). Episodes of SE were classified as refractory in 81 (79.4%) cases. Episodes of >60 minutes were more frequent in patients diagnosed with epilepsy (<i>P</i>=0.036), focal motor SE (<i>P</i><0.001), and non-convulsive SE (<i>P</i>=0.037). The in-hospital mortality rate was 2.9%. Conclusion: Most of our findings are in accord with the current literature. Epilepsy, non-convulsive SE, and focal motor SE were associated with prolonged duration (>60 minutes), which reinforces the significance of the underlying neurological disease and semiological standardization in pediatric SE.

Treatment of pediatric convulsive status epilepticus.

Status epilepticus is one of the most common life-threatening neurological emergencies in childhood with the highest incidence in the first 5 years of life and high mortality and morbidity rates. Although it is known that a delayed treatment and a prolonged seizure can cause permanent brain damage, there is evidence that current treatments may be delayed and the medication doses administered are insufficient. Here, we summarize current knowledge on treatment of convulsive status epilepticus in childhood and propose a treatment algorithm. We performed a structured literature search via PubMed and ClinicalTrails.org and identified 35 prospective and retrospective studies on children <18 years comparing two and more treatment options for status epilepticus. The studies were divided into the commonly used treatment phases. As a first-line treatment, benzodiazepines buccal/rectal/intramuscular/intravenous are recommended. For status epilepticus treated with benzodiazepine refractory, no superiority of fosphenytoin, levetirazetam, or phenobarbital was identified. There is limited data on third-line treatments for refractory status epilepticus lasting >30 min. Our proposed treatment algorithm, especially for children with SE, is for in and out-of-hospital onset aids to promote the establishment and distribution of guidelines to address the treatment delay aggressively and to reduce putative permanent neuronal damage. Further studies are needed to evaluate if these algorithms decrease long-term damage and how to treat refractory status epilepticus lasting >30 min.

CLINICAL SPECTRUM ANDETIOLOGY OF CHILDHOOD STATUS EPILEPTICUS IN A TEACHING HOSPITAL, KASHMIR, INDIA

Objective: The study aimed to ascertain clinicalspectrum and different etiologies of convulsive status epilepticus in children. Methods: Hospital based prospective observational study performed in department of Pediatrics in Children Hospital Government Medical College Srinagar Kashmir India from October 2020 to September 2022.Data were recorded with the help of a pre-formed proforma. Results: In this study, 184 cases of status epilepticus were included. The infants (less than 1-year)accountfor 23.9% ofthetotalcases(n=184) and67.4% children were in the age group &lt; 5 years. The total number of cases in the age group &gt;10yrs was only 6.5%.Outof184children,malechildrenwere102(55.4%)andfemalechildrenwere82(44.6%).We found that 81.5%ofthecases of CSE reachedEmergency Room (ER)within30-60minutes after seizure initiation and18.5%reachedafter 60 minutes. Themostcommonetiologyassociatedwithstatusepilepticuswasremotecauses like post HIE or cerebral palsy, seen in 25.54% cases, followed by acute CNS infection in 18.45 cases (pyogenic meningitis 10.3%, viral encephalitis 4.9%, and tubercular meningitis 3.26%). Conclusion: The outcome was better for patients who had less seizure duration and received early effective standard treatment protocol within a given time frame. The patients who had prolonged seizures or first treatment hadapoor outcome. Our study reveals that though we have successfully decreased the infant mortality rate, still there is large scope for decreasing morbidity by improving the neonatal care services across Kashmir and the intact Neonate intact Nation should be our mission and passion. Furthermore, it seems very imperative that all patients of CSE should receive early effective standard treatment at doorsteps to decrease the associated morbidity and mortality.

Management of status epilepticus in childhood: a survey conducted at pediatric hospitals in the City of Buenos Aires.

Introduction. Status epilepticus is the most common neurological emergency. Although mortality in children is low, morbidity may exceed 20%. Objective. To evaluate the management of status epilepticus by pediatricians who usually treat this condition. Population and methods. Descriptive, cross-sectional study based on a survey administered to physicians from 3 pediatric hospitals in the City of Buenos Aires. Results. A total of 292 surveys were administered (complete response rate as high as 86%); 77% were administered to pediatricians and 16% to intensive care specialists. Forty-seven percent of the participants reported that they administer the first dose of a benzodiazepine within the correct timeframe; 56% use intrarectal diazepam when intravenous access is not available; 95% choose lorazepam as the initial benzodiazepine if an intravenous line is available; 58% initiate the administration of a second-line drug within the correct timeframe; 84% administer phenytoin as the first-choice, second-line drug; and 33% do not measure treatment time. Overall adherence to international recommendations was 17%. Conclusions. Our study highlights poor adherence of pediatricians to international guidelines, particularly in time-dependent decisions. Greater heterogeneity was observed in treatment approaches as the treatment algorithm progressed.

Efficacy and Safety Comparison Between Lorazepam and Diazepam in Treating Convulsive Status Epilepticus in Children: An Evidence-Based Case Report

Introduction: Indonesia still recommends diazepam for epilepsy, but the International League Against Epilepsy increasingly favours lorazepam. Some reports indicate diazepam being less effective and causing side effects. This report presents a difficult-to-treat convulsive status epilepticus (CSE) case in a 10-month infant who received diazepam, questioning if intravenous/rectal lorazepam is a better initial therapy than diazepam for hospitalized children with CSE. Methods: Following the patient-intervention-comparison-outcome (PICO) formula, we searched for evidence in four journal databases (Pubmed, Proquest, EBSCOHost, and Cochrane). Studies meeting inclusion and exclusion criteria were appraised. Results: Through three systematic reviews and meta-analyses, our clinical query was addressed. One study revealed that rectal lorazepam was more effective in stopping seizures than rectal diazepam (RR 2.86). Meanwhile, two studies found that intravenous lorazepam exhibited similar efficacy in seizure cessation compared to intravenous diazepam (RR 1.04 and OR 1.03, respectively). Both drugs showed no significant difference in the time required to stop seizures or the necessity for additional doses or adjunctive medications to achieve such cessation, nor in the likelihood of refractory seizure within 24 hours. Two studies indicated that intravenous lorazepam had a reduced risk of respiratory depression (RR 0.71 and OR 0.62, respectively). Regardless of the administration route, lorazepam was linked to a lower probability of ICU admission (RR 0.15) than diazepam. Conclusion: Intravenous lorazepam and diazepam are equally effective for treating CSE, but rectal lorazepam is considered better at stopping seizures and preventing their recurrence compared to diazepam. Furthermore, lorazepam is deemed safer, especially when given intravenously.

Ketamine as advanced second-line treatment in benzodiazepine-refractory convulsive status epilepticus in children.

Status epilepticus (SE) is one of the most common neurological emergencies in children. To date, there is no definitive evidence to guide treatment of SE refractory to benzodiazepines. The main objectives of treatment protocols are to expedite therapeutic decisions and to use fast- and short-acting medications without significant adverse effects. Protocols differ among institutions, and most frequently valproate, phenytoin, and levetiracetam are used as second-line treatment. After failure of first- and second-line medications, admission to the intensive care unit and continuous infusion of anesthetics are usually indicated. Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that has been safely used for the treatment of refractory SE in adults and children. In animal models of SE, ketamine demonstrated antiepileptic and neuroprotective properties and synergistic effects with other antiseizure medications. We reviewed the literature to demonstrate the potential role of ketamine as an advanced second-line agent in the treatment of SE. Pharmacological targets, pathophysiology of SE, and the receptor trafficking hypothesis are reviewed and presented. The pharmacology of ketamine is outlined with related properties, advantages, and side effects. We summarize the most recent and relevant publications on experimental and clinical studies on ketamine in SE. Key expert opinion is also reported. Considering the current knowledge on SE pathophysiology, early sequential polytherapy should include ketamine for its wide range of positive assets. Future research and clinical trials on SE pharmacotherapy should focus on the role of ketamine as second-line medication.

儿童惊厥性癫痫持续状态的研究进展

儿童惊厥性癫痫持续状态的研究进展

Comparison of levetiracetam as second-line drug with fosphenytoin in convulsive status epilepticus among children: A single center, open-label randomized controlled trial

Background: Status epilepticus (SE) is the most common neurologic emergency in the pediatric age group often serious and life-threatening. Although newer drugs were used, morbidity and mortality are still high. This study was done to compare the efficacy of levetiracetam with the existing second-line drug fosphenytoin in the treatment of SE.Subjects and Methods: This was a prospective, randomized parallel group trial from Pediatric Intensive Care Unit of a Tertiary Care Institute. One hundred children were recruited according to the inclusion and exclusion criteria, 50 in fosphenytoin group and 50 in levetiracetam group. Two groups were compared with respect to clinical cessation of seizures, recurrence, adverse event, and outcome.Results: Male-to-female ratio was 1.45:1. Seizure were controlled in 37 (74%) in fosphenytoin group and 28 (56%) in levetiracetam group) (P = 0.059). The mean time for cessation of seizures was 11.16 ± 3.58 min in fosphenytoin group as compared to was 12.78 ± 3.07 min in levetiracetam group (P = 0.059) The seizure recurrence in first 24 h (18 [36%] vs. 12 [24%]) (P = 0.643) and development of shock (14 [28%] vs. 11 [22%]) (P = 0.488) was comparable in two groups. Overall mortality was 10 (20%) in fosphenytoin group as compared to 7 (14%) levetiracetam group (P = 0.281).Conclusions: Efficacy of intravenous levetiracetam is comparable to fosphenytoin as a second-line medication in the management of convulsive SE in children.

Prediction and assessment of acute encephalopathy syndromes immediately after febrile status epilepticus

ObjectiveThis study aimed to predict occurrence of acute encephalopathy syndromes (AES) immediately after febrile status epilepticus in children and to explore the usefulness of electroencephalogram (EEG) in the early diagnosis of AES. MethodsWe reviewed data from 120 children who had febrile status epilepticus lasting >30 min and were admitted to our hospital between 2012 and 2019. AES with reduced diffusion on brain magnetic resonance imaging was diagnosed in 11 of these patients. EEG and serum cytokines were analyzed in AES patients. Clinical symptoms and laboratory data were compared between AES and non-AES patients. Logistic regression analysis was used to identify early predictors of AES. ResultsMultivariate logistic regression identified serum creatinine as a risk factor for developing AES. A scoring model to predict AES in the post-ictal phase that included serum creatinine, sodium, aspartate aminotransferase, and glucose was developed, and a score of 2 or more predicted AES with sensitivity of 90.9% and specificity of 71.6%. Post-ictus EEG revealed non-convulsive status epilepticus in four of the seven AES patients. ConclusionChildren with febrile status epilepticus may be at risk of developing severe AES with reduced diffusion. Post-ictus EEG and laboratory data can predict the occurrence of severe AES.

Current Management of Generalized Convulsive Status Epilepticus in Children.

Generalized convulsive status epilepticus (GCSE) in pediatric patients is an emergency condition with high morbidity and mortality and potentially irreversible brain damage, leading to cognitive deterioration, psychomotor retardation, chronic epilepsy with recurring seizures, and other complications. Treatment must be initiated in the impending GCSE phase, within five minutes of the onset of a generalized convulsive seizure. Early initiation of treatment and adequate therapy is a prerequisite for a good patient outcome.

Optimal Management of Status Epilepticus in Children in the Emergency Setting: A Review of Recent Advances.

Convulsive status epilepticus (CSE) is the most common neurological emergency in children and the second most common neurological emergency in adults. Mortality is low, but morbidity, including neuro-disability, learning difficulties, and a de-novo epilepsy, may be as high as 22%. The longer the duration of CSE, the more difficult it is to terminate, and the greater the risk of morbidity. Convulsive status epilepticus is usually managed using specific national or local algorithms. The first-line treatment is administered when a tonic-clonic or focal motor clonic seizure has lasted five minutes (impending or premonitory CSE). Second-line treatment is administered when the CSE has persisted after two doses of a first-line treatment (established CSE). Randomised clinical trial (RCT) evidence supports the use of benzodiazepines as a first-line treatment of which the most common are buccal or intra-nasal midazolam, rectal diazepam and intravenous lorazepam. Alternative drugs, for which there are considerably less RCT data, are intra-muscular midazolam and intravenous clonazepam. Up until 2019, phenobarbital and phenytoin (or fosphenytoin) were the preferred second-line treatments but with no good supporting RCT evidence. Robust RCT data are now available which has provided important information on second-line treatments, specifically phenytoin (or fosphenytoin), levetiracetam and sodium valproate. Lacosamide is an alternative second-line treatment but with no supporting RCT evidence. Current evidence indicates that first, buccal or intranasal midazolam or intravenous lorazepam are the most effective and the most patient and carer-friendly first-line anti-seizure medications to treat impending or premonitory CSE and second, that there is no difference in efficacy between levetiracetam, phenytoin (or fosphenytoin) or sodium valproate for the treatment of established CSE. Pragmatically, levetiracetam or sodium valproate are preferred to phenytoin (or fosphenytoin) because of their ease of administration and lack of serious adverse side-effects, including potentially fatal cardiac arrhythmias. Sodium valproate must be used with caution in children aged three and under because of the rare risk of hepatotoxicity and particularly if there is an underlying mitochondrial disorder.

Costs and cost-driving factors of acute treatment of status epilepticus in children and adolescents: A cohort study from Germany.

To provide data on inpatient costs and cost-driving factors in children and adolescents due to non-refractory (NSE), refractory (RSE), and super-refractory status epilepticus (SRSE). All children and adolescents treated for status epilepticus (SE) between 2011 and 2018 at the Frankfurt University Hospital were analyzed for health care utilization. We evaluated 223 admissions in 174 patients (6.8±5.1 years, median 5.5 years, range 0.1-17.5 years, 109 males [62.6%]) treated for SE. Mean costs of hospital treatment were €5,711 (median €2,330, range=€654-€102,414) per patient per admission, with a mean length of stay (LOS) of 9.2 days (median 5.0, range=1-101), resulting in mean costs of €621 per SE treatment day. Course of SE had a significant impact on the mean costs, which were €3,386 in NSE (median €2,139, range €654-€38,236, €529 per treatment day; 37% of total inpatient costs due to SE), €7,409 in RSE (median €2,772, range €700-€38,236; €612 per treatment day, 38% of total inpatient costs due to SE) and €17,436 in SRSE (median €6,911, range €2,138-102,414; €842 per treatment day, 25% of total inpatient costs due to SE). Independent cost-driving factors were three or more treatment steps, acute-symptomatic etiology, and unfavorable modified Rankin Scale score at admission. Increased LOS was predicted by three or more treatment steps and unfavorable modified Rankin Scale score at admission. Overall mortality at discharge was 1.3% (three patients). Acute treatment of SE, and particularly RSE and SRSE, is associated with high hospital costs and prolonged LOS. Patients with disabilities are at risk for an unfavorable course of SE, resulting in prolonged LOS. In general, mortality associated with SE is low in children and adolescents, however three or more treatment steps are associated with high treatment costs.

Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children

BackgroundFebrile status epilepticus is the most common form of status epilepticus in children. No previous reports compare the effectiveness of treatment strategies using fosphenytoin (fPHT) or phenobarbital (PB) and those using anesthetics as second-line anti-seizure medication for benzodiazepine-resistant convulsive status epilepticus (CSE). We aimed to examine the outcomes of various treatment strategies for febrile convulsive status epilepticus (FCSE) in a real-world setting while comparing the effects of different treatment protocols and their presence or absence.MethodsThis was a single-center historical cohort study that was divided into three periods. Patients who presented with febrile convulsive status epilepticus for ≥60 min even after the administration of at least one anticonvulsant were included. During period I (October 2002–December 2006), treatment was performed at the discretion of the attending physician, without a protocol. During period II (January 2007–February 2013), barbiturate coma therapy (BCT) was indicated for FCSE resistant to benzodiazepines. During period III (March 2013–April 2016), BCT was indicated for FCSE resistant to fPHT or PB.ResultsThe rate of electroencephalogram monitoring was lower in period I than period II+III (11.5% vs. 85.7%, p<0.01). Midazolam was administered by continuous infusion more often in period I than period II+III (84.6% vs. 25.0%, p<0.01), whereas fPHT was administered less often in period I than period II+III (0% vs. 27.4%, p<0.01). The rate of poor outcome, which was determined using the Pediatric Cerebral Performance Category scale, was higher in period I than period II+III (23.1% vs. 7.1%, p=0.03). The rate of poor outcome did not differ between periods II and III (4.2% vs. 11.1%, p=0.40).ConclusionsWhile the presence of a treatment protocol for FCSE in children may improve outcomes, a treatment protocol using fPHT or PB may not be associated with better outcomes.