Main Article Content

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.

Keywords

seizures status epilepticus

Article Details

Author Biography

Jo M Wilmshurst, Red Cross War Memorial Children's Hospital & University of Cape Town

Head of Paediatric Neurology
Dept of Paediatric Neurology
How to Cite
Wilmshurst, J. M. (2015). Management of Children with Status Epilepticus. Journal of the International Child Neurology Association, 1(1). https://doi.org/10.17724/jicna.2015.104

References

  1. Zawadzki L, Stafstrom CE (2010) Status epilepticus treatment and outcome in children: what might the future hold? Semin. Pediatr. Neurol. 17 (3):201-5. Crossref Pubmed

  2. Meldrum BS, Vigouroux RA, Brierley JB (1973) Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol 29 (2):82-7. Pubmed

  3. Lowenstein DH, Bleck T, Macdonald RL (1999) It's time to revise the definition of status epilepticus. Epilepsia 40 (1):120-2. Pubmed

  4. Chin RF, Neville BG, Peckham C, Wade A, Bedford H, Scott RC (2008) Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol 7 (8):696-703. Crossref Pubmed

  5. Scott RC, Surtees RA, Neville BG (1998) Status epilepticus: pathophysiology, epidemiology, and outcomes. Arch Dis Child 79 (1):73-7. Pubmed

  6. Holtkamp M, Othman J, Buchheim K, Meierkord H (2005) Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 76 (4):534-9. Crossref Pubmed

  7. Schreiber JM, Gaillard WD (2011) Treatment of refractory status epilepticus in childhood. Curr Neurol Neurosci Rep 11 (2):195-204. Crossref Pubmed

  8. Haafiz A, Kissoon N (1999) Status epilepticus: current concepts. Pediatr Emerg Care 15 (2):119-29. Pubmed

  9. Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG et al. (2010) Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology 74 (8):636-42. Crossref Pubmed

  10. Fountain NB (2000) Status epilepticus: risk factors and complications. Epilepsia 41 Suppl 2 ():S23-30. Pubmed

  11. Lacroix J, Deal C, Gauthier M, Rousseau E, Farrell CA (1994) Admissions to a pediatric intensive care unit for status epilepticus: a 10-year experience. Crit Care Med 22 (5):827-32. Pubmed

  12. Newton CR (2009) Status epilepticus in resource-poor countries. Epilepsia 50 Suppl 12 ():54-5. Crossref Pubmed

  13. Sahin M, Menache CC, Holmes GL, Riviello JJ (2001) Outcome of severe refractory status epilepticus in children. Epilepsia 42 (11):1461-7. Pubmed

  14. Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC et al. (2006) Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 368 (9531):222-9. Crossref Pubmed

  15. Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K et al. (2006) Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 67 (9):1542-50. Crossref Pubmed

  16. Kurtz P, Hanafy KA, Claassen J (2009) Continuous EEG monitoring: is it ready for prime time? Curr Opin Crit Care 15 (2):99-109. Crossref Pubmed

  17. Subbaswamy A, Hsu AA, Weinstein S, Bell MJ (2009) Correlation of cerebral Near-infrared spectroscopy (cNIRS) and neurological markers in critically ill children. Neurocrit Care 10 (1):129-35. Crossref Pubmed

  18. Scott RC, Besag FM, Neville BG (1999) Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 353 (9153):623-6. Crossref Pubmed

  19. Jeannet PY, Roulet E, Maeder-Ingvar M, Gehri M, Jutzi A, Deonna T (1999) Home and hospital treatment of acute seizures in children with nasal midazolam. Eur J Paediatr Neurol 3 (2):73-7. Crossref Pubmed

  20. Loddenkemper T, Goodkin HP (2011) Treatment of pediatric status epilepticus. Curr Treat Options Neurol 13 (6):560-73. Crossref Pubmed

  21. Appleton R, Macleod S, Martland T (2008) Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev (3):CD001905. Crossref Pubmed

  22. Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst. Rev. 2008 Jul 16;(3)(3):CD001905.

  23. Prasad A, Williamson JM, Bertram EH (2002) Phenobarbital and MK-801, but not phenytoin, improve the long-term outcome of status epilepticus. Ann Neurol 51 (2):175-81. Pubmed

  24. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ et al. (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339 (12):792-8. Crossref Pubmed

  25. Wilmshurst JM, van der Walt JS, Ackermann S, Karlsson MO, Blockman M (2010) Rescue therapy with high-dose oral phenobarbitone loading for refractory status epilepticus. J Paediatr Child Health 46 (1-2):17-22. Crossref Pubmed

  26. Syed GB, Sharma DB, Raina RK (1986) Pharmacokinetics of phenobarbitone in protein energy malnutrition. Dev Pharmacol Ther 9 (5):317-22. Pubmed

  27. Yska JP, Essink GW, Bosch FH, Lankhaar G, van Sorge AA (2000) Oral bioavailability of phenobarbital: a comparison of a solution in Myvacet 9-08, a suspension, and a tablet. Pharm World Sci 22 (2):67-71. Pubmed

  28. Sahin M, Menache CC, Holmes GL, Riviello JJ (2003) Prolonged treatment for acute symptomatic refractory status epilepticus: outcome in children. Neurology 61 (3):398-401. Pubmed

  29. Rosenow F, Arzimanoglou A, Baulac M (2002) Recent developments in treatment of status epilepticus: a review. Epileptic Disord 4 Suppl 2 ():S41-51. Pubmed

  30. Hayashi K, Osawa M, Aihara M, Izumi T, Ohtsuka Y, Haginoya K et al. (2007) Efficacy of intravenous midazolam for status epilepticus in childhood. Pediatr Neurol 36 (6):366-72. Crossref Pubmed

  31. Lampin ME, Dorkenoo A, Lamblin MD, Botte A, Leclerc F, Auvin S (2010) [Use of midazolam for refractory status epilepticus in children]. Rev Neurol (Paris) 166 (6-7):648-52. Crossref Pubmed

  32. Crawford TO, Mitchell WG, Fishman LS, Snodgrass SR (1988) Very-high-dose phenobarbital for refractory status epilepticus in children. Neurology 38 (7):1035-40. Pubmed

  33. DeWolfe JL, Knowlton RC, Beasley MT, Cofield S, Faught E, Limdi NA (2009) Hyperammonemia following intravenous valproate loading. Epilepsy Res 85 (1):65-71. Crossref Pubmed

  34. Limdi NA, Knowlton RK, Cofield SS, Ver Hoef LW, Paige AL, Dutta S et al. (2007) Safety of rapid intravenous loading of valproate. Epilepsia 48 (3):478-83. Crossref Pubmed

  35. Rossetti AO, Bromfield EB (2005) Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology 65 (3):500-1; author reply 500-1. Pubmed

  36. Kirmani BF, Crisp ED, Kayani S, Rajab H (2009) Role of intravenous levetiracetam in acute seizure management of children. Pediatr Neurol 41 (1):37-9. Crossref Pubmed

  37. Abend NS, Monk HM, Licht DJ, Dlugos DJ (2009) Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med 10 (4):505-10. Crossref Pubmed

  38. Wilmshurst JM, Newton CR (2005) Withdrawal of older anticonvulsants for management of status epilepticus: implications for resource-poor countries. Dev Med Child Neurol 47 (4):219. Pubmed

  39. Mastrangelo M, Celato A (2012) Diagnostic work-up and therapeutic options in management of pediatric status epilepticus. World J Pediatr 8 (2):109-15. Crossref Pubmed

  40. World Health Organisation (2015, Feb 11). Antiepileptic drugs for acute convulsive seizures or status epilepticus in adults and children. Retrieved from http://www.who.int/mental_health/mhgap/evidence/epilepsy/q2/en/

  41. World Health Organisation. (2015, Feb 11). WHO Model Lists of Essential Medicines. Retrieved from http://www.who.int/medicines/publications/essentialmedicines/en/index.html

  42. Cite this article as: Wilmshurst JM.: Management of Children with Status Epilepticus. JICNA 2015 15:104. DOI: http://dx.doi.org/10.17724/jicna.2015.104

Similar Articles

<< < 1 2 3 4 5 6 > >> 

You may also start an advanced similarity search for this article.