Status Epilepticus In Children Research Articles

The need for improved management of status epilepticus in children in Australia: Time from seizure onset to treatment is consistently delayed.

To determine if the management of paediatric status epilepticus (SE) follows accepted clinical practice guidelines. Retrospective, consecutive series of patients with SE who attended the emergency departments from two NSW sites over a 12-month period. SE was defined as a convulsive seizure, 5min or more in duration. Time to presentation to the ED, time to first- and second-line treatment, number of benzodiazepine (BZD) doses given prior to intubation and adherence to guidelines were evaluated. The outcomes included seizure duration, need for respiratory support, admission to intensive care, morbidity and mortality. The time from onset of seizure to ED presentation was a median (p25-p75) time of 22 (15-40) min. Forty-eight of 59 presentations received pre-hospital midazolam. The median (p25-p75) time to first-line treatment was 15 (8-25) min and to second-line treatment was 43.5 (35-59) min. There was no significant difference in the results in the two hospitals. The total number of BZD doses ranged from 1 to 7 (median 3). There was non-adherence to the clinical practice guidelines in 55 (93.2%) of 59 presentations. We found excessive benzodiazepine use and delay in both definitive treatment of status epilepticus and in escalation from first- to second-line anticonvulsant treatment. This raises the need for rapid escalation of treatment. We propose a 'status epilepticus code' for emergency departments.

Facilitation of drug-resistant epilepsy and catastrophic status epilepticus in children with combined pituitary hormone deficiency.

Clinicians and researchers often focus on the primary cause of seizures and epilepsy, but outcomes in individual patients also depend on multiple other variables, which might be easy to adjust. Previous studies suggest mutual interactions between endocrine disorders and epilepsy. We therefore hypothesized that combined pituitary hormone deficiency (CPHD) facilitates seizures and epilepsy. This is a retrospective study from a pediatric center. We determined the proportion of CPHD patients with epilepsy and examined basic clinical features in this group. Patients with super-refractory status epilepticus (SRSE) were reviewed to identify subjects with co-morbid CPHD. Those cases were analyzed in detail. 12 of 73 CPHD patients (16%) also had epilepsy. Various etiologies of CPHD were represented, though five subjects had a cranial tumor or cortical malformation. Epilepsy was drug resistant in all but one patient. Among 12 identified patients with SRSE, 4 were unexpected new-onset cases. Three of these subjects also had CPHD with ACTH deficiency and a febrile infection prior to SRSE. Another common feature was the devastating clinical course: In all three patients, initial MRI already suggested severe neuronal damage, SRSE persisted for at least one week with ongoing need for anesthetic coma, and outcome was poor (two patients survived with major sequelae, one child deceased during the episode). Our findings indicate that CPHD may predispose for drug-resistant epilepsy and refractory seizures with catastrophic outcome. We suggest that in children with new-onset SRSE, screening for CPHD should be considered.

Clinical characteristics and outcome in children with convulsive status epilepticus

ABSTRACT Background: Status epilepticus (SE) is a serious neurological emergency that is associated with increased morbidity and mortality. There is emerging interest in understanding the clinical characteristics and identification of the prognosis of children with SE. Objective: To identify the clinical profile and prognosis of children presenting by status epilepticus. Methodology: This is a descriptive analytical study carried out on 31 children who presented by convulsive SE and were admitted to the pediatric intensive care unit. Clinical data, Complete blood count, C-reactive protein, erythrocyte sedimentation rate, serum glucose & electrolytes and cerebrospinal fluid analysis were estimated. Magnetic resonance imaging was done to all included children. Results: Most of the children who presented with SE were younger than 5 years of age (45.2% were <2 years and 32.2% were 2-5 years). 74.2% were males and 83.9% had generalized seizures. 29% had SE as a first presentation. 77.4% were known cases of epilepsy. Non epileptic causes included encephalitis (12.9%), febrile convulsion (a typical) (6.5%) and acute hypoxia (shocking) (3.2%). The main precipitating factors for SE were missing doses in 29%, acute febrile Illness in 12.9%, acute hypoxia in 6.5%, while precipitating factors could not be identified in 41.9% of children. Most children had normal MRI (64.5%). The commonest abnormalities were diffuse hypoxia and encephalitis (12.9% for each). 70.9% of children survived without neurological sequeals, 19.4% developed neurological sequels while 9.7% died. Non-epileptic etiology, febrile illness, hypoxia, elevated acute phase reactant (erythrocytes sedimentation rate and C-reactive protein) was significantly associated with poor outcome. Conclusion: Despite that epilepsy is the main cause of SE, non-epileptic causes are more serious and are associated with a worser outcome. Male gender, poor compliance to antiepileptic medications and febrile illness are linked to the development of SE in children. SE induced by hypoxia and encephalitis had the highest morbidity and mortality.

Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

Background: Optimal care of Convulsive status epilepticus (CSE) can be related to multiple barriers in resource-limited countries.&#x0D; Objectives and methods: Since limited data of CSE management are available from South-East Africa, we performed a retrospective analysis of the electronic records of pediatric patients with CSE admitted to the Maputo Central hospital from January 2016 until April 2019.&#x0D; Results: Our database consisted out of 39 patients. The average age was 5.15 (range 0.3-13.8) years and demographic characteristics did not show a relation to CSE characteristics or outcomes. However, the total stay in the hospital was negatively correlated with age (p=0.0314). Moreover, 14 patients needed to be admitted to the IC, which was correlated to having generalized motor seizures (p=0.0253), and a relatively higher need for a second AED to control their CSE (p=0.0131). Regarding AED use, the first AED was a IV benzodiazepine (BZD: midazolam (MIDA) or diazepam (DIAZ)) or IV phenytoin (PHEN) when BZDs were not available. There was no statistically significant difference between the efficacy of MIDA vs. DIAZ. Eleven patients received PHEN as a second-line drug, of which only two patients needed an additional dose of PHEN. None of the patients died and five patients (13.2%) had an extra comorbidity after CSE.&#x0D; Conclusions: Although limited AEDs were available in our study, compared to more AEDs in other developing and developed countries, we report the successful cessation of CSE in the majority of cases. We recommend strategies to improve prehospital management such as the use of non-IV BZD use, to limit the need for patients to be admitted to the IC and thereby potentially decreasing the number of AEDs, morbidity and hospital duration. Moreover, our data underline the conversion to second-line AEDs (PHEN) to be adequate in nearly all patients.

Clinical presentation of new onset refractory status epilepticus in children (the pSERG cohort).

ObjectiveWe aimed to characterize the clinical profile and outcomes of new onset refractory status epilepticus (NORSE) in children, and investigated the relationship between fever onset and status epilepticus (SE).MethodsPatients with refractory SE (RSE) between June 1, 2011 and October 1, 2016 were prospectively enrolled in the pSERG (Pediatric Status Epilepticus Research Group) cohort. Cases meeting the definition of NORSE were classified as "NORSE of known etiology" or "NORSE of unknown etiology." Subgroup analysis of NORSE of unknown etiology was completed based on the presence and time of fever occurrence relative to RSE onset: fever at onset (≤24 h), previous fever (2 weeks–24 h), and without fever.ResultsOf 279 patients with RSE, 46 patients met the criteria for NORSE. The median age was 2.4 years, and 25 (54%) were female. Forty (87%) patients had NORSE of unknown etiology. Nineteen (48%) presented with fever at SE onset, 16 (40%) had a previous fever, and five (12%) had no fever. The patients with preceding fever had more prolonged SE and worse outcomes, and 25% recovered baseline neurological function. The patients with fever at onset were younger and had shorter SE episodes, and 89% recovered baseline function.SignificanceAmong pediatric patients with RSE, 16% met diagnostic criteria for NORSE, including the subcategory of febrile infection‐related epilepsy syndrome (FIRES). Pediatric NORSE cases may also overlap with refractory febrile SE (FSE). FIRES occurs more frequently in older children, the course is usually prolonged, and outcomes are worse, as compared to refractory FSE. Fever occurring more than 24 h before the onset of seizures differentiates a subgroup of NORSE patients with distinctive clinical characteristics and worse outcomes.

Efficacy and Safety of Levetiracetam vs. Phenytoin as Second Line Antiseizure Medication for Pediatric Convulsive Status Epilepticus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To evaluate the efficacy and safety of levetiracetam (LEV) in comparison to phenytoin (PHT) as second line antiseizure medication (ASM) for Pediatric convulsive status epilepticus (SE). PubMed, Embase, Google scholar/Google, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) assessing LEV and PHT as second line agent for convulsive SE in children <18 years published between 1 January 2000 and 30 November 2020. The data were pooled regarding the proportion of children achieving seizure cessation within 5-60 min of completion of study drug infusion (primary outcome); and seizure cessation within 5 min, time to achieve seizure cessation, seizure recurrence between 1 to 24 h, intubation and cardiovascular instability (secondary outcomes). Data were analyzed using RevMan version 5.4 and quality analysis was done using Cochrane risk-of-bias tool. The study protocol was registered with PROSPERO. Twelve RCTs with 2293 children were included. Seizure cessation within 5-60 min was similar with both the drugs [82% in LEV vs. 77.5% in PHT, risk ratio (RR) = 1.04, 95% confidence interval (95% CI) 0.97-1.11, p = 0.30]. Seizure recurrences within 1-24 h was higher with PHT in comparison to LEV (16.6% vs. 9.7%, RR = 0.63, 95% CI 0.44-0.90, p = 0.01). Higher proportion of children in PHT group required intubation and mechanical ventilation (21.4% vs. 14.2%, RR = 0.54, 95% CI 0.30-0.98, p = 0.04). Seizure cessation within 5 min, time to achieve seizure cessation, and cardiovascular instability were similar with both the drugs. Three RCTs were at low risk of bias and nine were at high risk of bias. The efficacy of LEV is similar to PHT as second line ASM for Pediatric convulsive SE. Seizure recurrences between 1 to24 h and requirement of intubation and mechanical ventilation were significantly higher with PHT in comparison to LEV.

Utility of the END-IT Score to Predict the outcome of Childhood Status Epilepticus: A Retrospective Cohort Study.

Introduction:Scoring systems to predict outcomes in pediatric status epilepticus (SE) are limited. We sought to assess usefulness of the END-IT score in pediatric SE.Methodology:We conducted a retrospective study at a tertiary hospital in New Delhi, India. Children aged 1 month–18 years who presented with seizure for ≥5 min/actively convulsing to emergency were enrolled. END-IT score was calculated and correlated with outcome at discharge using Pediatric Overall Performance Category (POPC) scale, in-hospital mortality, and progression to refractory and super-refractory SE (SRSE).Results:We enrolled 140 children (mean age 5.8 years; 67.1% males). Seven children died and 15 had unfavorable outcomes. The predictive accuracy of END-IT at a cutoff of > 2: for unfavorable outcome (POPC score ≥3) was: sensitivity 0.73 (95% CI: 0.45–0.92), specificity 0.94 (95% CI: 0.89–0.98), PPV 0.61 (95% CI: 0.36–0.83), NPV 0.97 (95% CI: 0.92–0.99), positive likelihood ratio (13.09), F1 score (0.666); for death: sensitivity 0.86 (95% CI: 0.42–0.99), specificity 0.91 (95% CI: 0.85–0.95), PPV 0.33 (95% CI: 0.13–0.59), NPV 0.99 (95% CI: 0.96–1.00), F1 score (0.48); for RSE: sensitivity 0.80 (95%CI: 0.28–0.99), specificity 0.90 (95% CI: 0.83–0.94), PPV 0.22 (95% CI: 0.06–0.48) NPV 0.99 (95% CI: 0.96–1.00), F1 score (0.35); for SRSE: sensitivity 0.67 (95% CI: 0.22–0.96) specificity 0.75 (95% CI: 0.66–0.82), PPV 0.22 (95% CI: 0.06–0.48) NPV 0.98 (95% CI: 0.94–0.99), F1 score (0.33).Conclusion:We demonstrate utility of the END-IT score to predict short-term outcomes as well as progression to refractory and SRSE for the first time among children with SE.

Epidemiology and outcome of status epilepticus in children: a Scottish population cohort study.

To describe the epidemiology and outcomes of convulsive status epilepticus (CSE) since the introduction of buccal midazolam and the change in International League Against Epilepsy definition of CSE to include seizures of at least 5minutes. All children presenting to paediatric emergency departments with CSE (2011-2017) in Lothian, Scotland, were identified. Data, collated from electronic health records, included patient demographics, clinical characteristics, acute seizure management, and adverse outcomes (for example admission to intensive care). Six hundred and sixty-five children were admitted with CSE who had 1228 seizure episodes (381 males, 284 females; median age 3y 8mo; age range 0-20y 11mo). CSE accounted for 0.38% (95% confidence interval 0.34-0.42) of annual attendances at emergency departments. Annual prevalence was 0.8 per 1000 children aged 0 to 14 years. Thirty-four per cent of children had recurrent CSE. Sixty-nine per cent of seizures lasted 5 to 29minutes (median duration 10min). Buccal midazolam was given to 30% of children with CSE and had no effect on need for ventilatory support. Seventy per cent of children with CSE required hospital admission. Four per cent resulted in adverse outcome and there were only two deaths. Recurrent seizures, longer duration, and unprovoked seizures increased the odds of adverse outcome. Adverse outcomes have decreased and the use of buccal midazolam is promising. Identifying high-risk groups provides an opportunity for early intervention. These data form the basis for an extensive evaluation of acute seizure management and monitoring long-term outcomes. What this paper adds The annual prevalence of convulsive status epilepticus in Lothian, Scotland, was 0.8 per 1000 children. There was a decrease in case-fatality proportion from 3-9% to 0.2%. Use of buccal midazolam has increased, with no increase in adverse outcomes.

Focal nonconvulsive status epilepticus in children: clinical and electroencephalographic features in 38 patients

PurposeThe aim of this study was to characterize clinically, etiologically, and electroencephalographically focal Nonconvulsive Status Epilepticus (NCSE) in children. Moreover, we tried to identify focal NCSE features distinguishing between different ages, NCSE etiologies, and cases of de novo onset. MethodsWe retrospectively identified patients (aged 1 month to 18 years) who had EEG-documented focal NCSE between January 2001 and December 2019. We analyzed the clinical features, etiology, and EEG features of each event. ResultsThirty-eight patients were included in this study. NCSE had a de novo onset in 26 patients and was the first manifestation of previously undiagnosed epilepsy in 12 patients. NCSE etiology was acute symptomatic in 13 patients. Acute symptomatic NCSE events were mainly observed in hospitalized children, were usually longer, and had a significantly higher frequency of repetitive EEG patterns than other etiologies. In patients with epilepsy, the etiology of NCSE was remote symptomatic in 14, progressive in 6, and cryptogenic in 5; a definite or suspected genetic disorder was observed in 11. EEG localization was frequent in posterior regions (18 children). Eleven patients had refractory NCSE and 4 required admission to the intensive care unit. ConclusionFocal NCSE in children is more frequent in the first years of life, mainly involves posterior regions, and often has de novo onset. In the case of de novo focal NCSE both acute symptomatic NCSE and new-onset epilepsy must be considered and investigated. A higher frequency of repetitive EEG patterns and an inpatient setting are significantly associated with acute symptomatic NCSE.

Managing Status Epilepticus in a Child with Dravet Syndrome: How Difficult It Could Be?

AbstractPreviously known as severe myoclonic epilepsy of infancy, Dravet syndrome is characterized by febrile or afebrile prolonged hemiconvulsive seizures or generalized status epilepticus in an infant with previously normal development. Immediate management of status epilepticus is critical in these patients. Early control of status epilepticus prevents further brain damage; however, there is no consensus regarding the management of status epilepticus in children with Dravet syndrome, as many conventional antiseizure medications that are recommended in the management of status epilepticus worsen the seizures in these patients. A 2.5-year-old girl child patient was referred due to status epilepticus which was refractory to antiseizure medications. Sodium valproate, nitrazepam, ketogenic diet, intravenous phenytoin, and midazolam continuous infusion were administered. After controlling status epilepticus, the probable diagnosis of Dravet syndrome was proposed and confirmed by a mutation in SCN1A. As previously stated in numerous case reports, phenytoin worsens seizures in patients with Dravet syndrome. Therefore, it seems logical that in every infant with status epilepticus and probable Dravet syndrome, the practicing physician considers administering intravenous valproate or even midazolam continuous infusion instead of intravenous phenytoin.

Preparation, optimization, and evaluation of midazolam nanosuspension: enhanced bioavailability for buccal administration

Midazolam is considered as one of the best first-line drugs in managing status epilepticus in children who require emergency drug treatment. Due to poor water solubility, oral bioavailability of midazolam is relatively low. To improve its dissolution and absorption, midazolam nano-suspensions were formulated with different stabilizers using the ultrasonic technique. A combination of Tween 80 and Poloxamer (TP) was considered as one stabilizer and 3-methyl chitosan (TMC) as another stabilizer. The ratio of the stabilizers was selected as an independent variable, and their effects on the particle size and the zeta potential were evaluated by the simplex lattice mixture method. The freeze-dried optimized midazolam nano-suspension powder was characterized by particle-size analysis, SEM, the stability test, and the dissolution test. The optimized midazolam nano-suspension (containing 76% TMC and 24% TP) had a mean particle size of 197 ± 7nm and a zeta potential of 31 ± 4 (mV). The stability test showed that the midazolam nano-suspension is stable for 12months. In the in vitro dissolution test, the midazolam nano-suspension showed a marked increase in the drug dissolution percentage versus coarse midazolam. In the in vivo evaluation, the midazolam nano-suspension exhibited a significant increase in the Cmax and the AUC0-5, and a major decrease in Tmax. The overall results indicate the nano-suspension of midazolam is a promising candidate for managing status epilepticus in children in emergency situation.

Clinical guideline: status epilepticus in children and adults

Clinical guideline: status epilepticus in children and adults

Status epilepticus in children at a tertiary care centre

Status epilepticus in children at a tertiary care centre

Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus.

Background and PurposeStatus epilepticus (SE) is a common pediatric neurological emergency that requires immediate and vigorous management. Currently, phenytoin is the most common agent used in the setting of SE following benzodiazepine for further seizure prevention. Other drugs recently introduced for management of SE are valproic acid and levetiracetam.MethodsThis prospective randomized study included 150 pediatric patients admitted as SE. Patients were randomized into three equal groups (50 each) to receive one of the three anticonvulsants in addition to standard treatment. Patients were monitored in hospital regarding their vitals, time to regain consciousness, and seizure recurrence.ResultsAt 24 hours seizures were controlled in 44 patients (88%) in phenytoin group, 39 patients (78%) in levetiracetam (LEV) group and 46 patients (92%) in valproate (VAL) group (p=0.115). The mean time to regain consciousness in phenytoin, LEV and VAL groups was 122.3±45.4, 120.8±42.8, and 75.0±30.7 minutes (mean±standard deviation) respectively. Patients in VAL group regained consciousness earlier than both phenytoin and LEV group patients (p<0.0001). At 3 months follow-up, seven (14.28%) out of 49 patients in phenytoin group, 14 (28.57%) out of 49 in LEV group and two (4%) out of 50 patients in VAL group had a seizure recurrence (p=0.0032).ConclusionsIn our study we found that both IV LEV and IV VAL safe and efficacious. The primary outcome, seizure recurrence at 24 hours, did not show a statistically significant difference in three groups (p>0.05). Also, seizure recurrence at 1 week did not reach a statistically significant difference. However, time to regain consciousness and seizure recurrence at 3 months was significantly less in VAL group (p<0.05).

Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran

Background:Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus.Methods:This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study.Results:The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p&lt;0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36%versus14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p&lt;0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology.Conclusion:Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.

A comparison of intravenous midazolam and diazepam in management of status epilepticus in children.

To compare the efficacy of intravenous midazolam and diazepam in the management of status epilepticus seizures in children. The comparative study was conducted in the paediatric neurological emergency unit of The Children's Hospital and the Institute of Child Health, Multan, Pakistan, from December 15, 2018, to May 14, 2019, and comprised paediatric patients of status epilepticus seizures which were divided into Diazepam and Midazolam groups. Data was analysed using Graph-Pad Prism 5. Of the 164 patients, 82(50%) were in each of the two groups. There was no significant difference between the groups in terms of weight, age, residence area of patients and mean duration of seizures (p>0.05). Status epilepticus seizures subsided after intravenous midazolam administration in 77(93.90%) cases, while success in the diazepam group 64(78.05%) (p<0.05). Mean time taken by midazolam to halt seizures was significantly shorter than diazepam (p<0.05) and less cases of treatment failure were observed with intravenous midazolam (p<0.05). Somnolence was observed after diazepam administration in 47(57.3%) cases (p=0.0001). Intravenous midazolam was found to be superior in efficacy than intravenous diazepam in controlling status epilepticus seizures.

Clinical Feature and Outcome of Childhood Status Epilepticus in a Teaching Hospital, Odisha, India.

ObjectivesThe main aim is to find out the clinical feature and outcome of status epilepticus (SE) in children managed in a teaching hospital. The secondary aim is to identify the risk factors influencing the adverse outcomes.MethodsIn this prospective cohort, children aged 1 month to 14 years with SE as per the International League Against Epilepsy’s new guideline (2016) who presented to the emergency department during the period of November 2017 to October 2019 were enrolled. Clinical profile, treatment, and outcome of cases (n = 94) were noted.ResultsThe majority of children, 60 (63.82%), were less than five years of age. Prior history of seizures was present in 33 (35.1%) cases, whereas 61 (64.9%) cases presented with SE as the first episode of seizure. In 14 (42.4%) previous seizure cases, SE was due to drug default. No response to first-line antiepileptic drug (AED) was seen in 84 (89.37%) cases. Acute symptomatic etiology was the commonest etiology of SE in 64 (68%) cases, of which neuro-infections accounted for 44 (46.80%) cases. Longer duration (>60 minutes) of status (p < 0.01), ventilator support (p < 0.0001), and circulatory impairment (p < 0.0001) were attributable risk factors for mortality. A total of 28 children died (mortality rate, 29.8%), and 11 showed the persistence of their neuro-deficit.ConclusionsNeuro-infection is the most common etiology of SE in children. Longer duration of SE, more lag time for receiving the first AED, respiratory failure, and presence of shock are independent predictors for poor outcome. Hence, cessation of convulsion at the earliest leads to improved outcomes.

Planning for success: overcoming challenges to recruitment and conduct of an open-label emergency department–led paediatric trial

BackgroundKey challenges to the successful conduct of The Emergency treatment with Levetiracetam or Phenytoin in Status Epilepticus in children (EcLiPSE) trial were identified at the pre-trial stage. These included practitioner...

Seven-step framework to enhance practitioner explanations and parental understandings of research without prior consent in paediatric emergency and critical care trials

BackgroundAlternatives to prospective informed consent enable the conduct of paediatric emergency and critical care trials. Research without prior consent (RWPC) involves practitioners approaching parents after an intervention has been given...

Comparison of phenobarbital and sodium valproate for the treatment of status epilepticus in children.

Objectives: Seizure is considered to be one of the commonest emergency involving more than half of the admissions in Pediatric Neurology wards. It has been well documented that proper management not only improves the prognosis but also decrease complications in these children. This study was planned to compare phenobarbital against sodium valproate for the treatment of status epilepticus (SE) in children. Study Design: Randomized clinical trial. Setting: Emergency Department of Pediatrics Medicine, the Baqai University and Medical College, Karachi. Period: 15th July 2018 to 31st December 2018. Material &amp; Methods: A total of 100 children (50 in each group) with seizure lasting longer than 5 minutes, aged 6 months to 12 years, did not respond to diazepam (0.2mg/kg) within five minutes, were enroll. Randomization was done using lottery system where Group A was nominated who used sodium valproate and Group B, phenobarbital. Good response was labeled if a child’s seizure was controlled within 20 minutes of treatment. Results: Out of total of 100 children included in the present study, there were 60 (60.0%) male and 40 (40.0%) female. Mean age of the children was 5.4 years with standard deviation of 2.2 years. As far as type of seizures are concerned, there were 43 (43.0%) children presented with febrile convulsions (FC) while 57 (57.0%) with SE. Overall, positive response was noted in 69 (69.0%) children. Response in between both the groups turned out to be of statistical significance as more children, 40 (80.0%) showed positive response in Group B in comparison to 29 (58.0%) in Group A (p value = 0.017). Amongst children with positive response, the difference between both the study groups was significant in relation to seizure types as 75.9% of children with SE showed positive response with sodium valproate while 52.5% children with FC showed positive response in Group B (p value=0.018). Conclusion: Overall, both study drugs showed good positive response but phenobarbital when compared to sodium valproate is a better choice for controlling seizure in pediatric population. Sodium valproate showed greater effectiveness when used in children with SE while phenobarbital was comparatively more effective in febrile convulsion.