Review article
https://doi.org/10.26800/LV-145-supl1-28
Management of pediatric status epilepticus – diagnostic and therapeutic procedures
Nina Barišić
; Dječja bolnica Srebrnjak, Zagreb
Filip Rubić
Abstract
Status epilepticus is the most common neuropediatric emergency in emergency departments, accounting for 1% of all emergencies. The aim of the manuscript is the rationalization of diagnostic recommendations and therapeutic procedures for status epilepticus in pediatrics according to age and circumstances. Motor generalized epileptic status lasting longer than 4 minutes should be terminated optimally within 5–20 minutes of (epileptic status) ES duration, primarily i.v. using diazepam (0.2 mg/kg), and in the newborn, phenobarbitone
intravenous (i.v.) 20 mg/kg in hospital conditions. In outpatient settings, benzodiazepines are used, buccal midazolam, (for infants older than 3 months), or midazolam intramuscular (i.m.) or diazepam rectal tube for children >12 months, maximum 2 doses with an interval of 5 minutes if ES does not stop. If ES is refractory, 20 minutes after onset levetiracetam 40mg/kg i.v. is used or phenobarbitone, with B6 100 mg i.v in the newborn. In super-refractory status, anesthetics are used: midazolam in infusion – or ketamine i.v. in infusion. Status epilepticus for a maximum of 10 minutes from the beginning of the duration, is treated out of hospital in Level I, after a clinical exam and history, by stopping the seizure. Child is transported afterward to 2nd, and the newborn and infant optimally to 3rd level of care if feasible. Benzodiazepines are effective in stopping 80–90% of epileptic seizures in the impending phase before the development of established status SE. There is no statistically significant difference in efficacy between second-line antiepileptic drugs. Levetiracetam i.v. is the drug of the first choice from the second line due to the possibility of quick preparation. There is not enough evidence to recommend
anesthetics from the 3rd line of treatment for SE. In newborns, infants and children with ES, is necessary to rule out infection of the central nervous system (CNS), ischemia, intracranial hemorrhages, structural abnormalities and to carry out metabolic and genetic investigations. Brain MR imaging is indicated in each patient with status epilepticus. Video EEG monitoring is necessary in the diagnosis of primarily nonconvulsive ES, which is a frequent continuum of convulsive ES, and mandatory in monitoring the effectiveness of ES therapy with antiepileptic drugs and anesthetics.
Keywords
STATUS EPILEPTICUS; DIAGNOSIS; THERAPY; LEVELS OF CARE; RECOMMENDATIONS; CHILDREN; NEWBORNS
Hrčak ID:
300855
URI
Publication date:
17.4.2023.
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