Antiepileptic drugs should be administered concurrently with benzodiazepines. If the second dose of benzodiazepines does not abort seizures, then treat as refractory status epilepticus. Refractory status epilepticus should be treated with a continuous infusion of an antiepileptic drug. Choices include an intravenous IV infusion of midazolam, pentobarbital, thiopental, or propofol propofol infusion should not be used in children due to the risk of propofol infusion syndrome.
A neurologist should be consulted early in the management, simultaneously with the administration of first-line therapy. Differential Diagnosis Differential diagnoses of status epilepticus include: Acute intoxication.
Prognosis The mortality rate for patients with the first episode of generalized convulsive status epilepticus is between 16 to 20 percent. Complications Complications of status epilepticus can be separated into medical and neurological complications and also immediate and delayed complications. Consultations Neurology Neurocritical care. Pearls and Other Issues There are known risks of congenital disabilities due to exposure to some antiepileptic drugs phenytoin, valproate sodium, and phenobarbital during the first trimester of pregnancy.
Enhancing Healthcare Team Outcomes Status epilepticus is best managed by an interprofessional team that includes emergency and neurology nurses. Once the patient is stable, investigations can begin. Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Xu MY. Poststroke seizure: optimising its management. Stroke Vasc Neurol. Front Neurol. Seizure and status epilepticus in chronic subdural hematoma. Acta Neurol Scand.
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Refractory status epilepticus: a prospective observational study. Recurrence of afebrile status epilepticus in a population-based study in Rochester, Minnesota. Crit Care Med. Status Epilepticus. In: StatPearls [Internet]. In this Page.
Related information. Similar articles in PubMed. Duration of focal complex, secondarily generalized tonic-clonic, and primarily generalized tonic-clonic seizures--A video-EEG analysis.
Epilepsy Behav. Epub Apr Review Generalized convulsive status epilepticus in the adult. Treiman DM. Treatment of Convulsive Status Epilepticus. Convulsive status epilepticus CSE is a medical emergency that requires prompt treatment. While there is high-quality evidence to support use of benzodiazepines as first-line therapy for CSE, the historical use of phenytoin as the second-line therapy for benzodiazepine-resistant seizures is based on limited evidence.
Since the approval of an intravenous formulation of levetiracetam in , it has been considered as an alternative medication for use in benzodiazepine-resistant CSE as it can be administered quickly as an intravenous push, has minimal drug interactions, reliable pharmacokinetics and few serious side effects.
Thus, there has been a recent explosion in the number of randomised controlled trials RCTs comparing the safety and efficacy of levetiracetam for benzodiazepine-resistant CSE, with 10 RCTs reported since Similarly, in light of recent data on safety and efficacy of levetiracetam, at least three systematic reviews with meta-analyses are reported so ….
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Provenance and peer review Commissioned; internally peer reviewed. You will be able to get a quick price and instant permission to reuse the content in many different ways. Skip to main content. Log in via OpenAthens. Journal List J Clin Med v. J Clin Med. Published online Apr Douglas M.
Smith , Emily L. McGinnis , Diana J. Walleigh , and Nicholas S. Gretchen M. Brophy, Academic Editor and Paul M. Vespa, Academic Editor. Author information Article notes Copyright and License information Disclaimer. Received Mar 21; Accepted Apr 7. This article has been cited by other articles in PMC. Abstract Status epilepticus is a common pediatric neurological emergency. Keywords: status epilepticus, pediatric, seizure. Introduction Status epilepticus is characterized by prolonged or recurrent seizures without a return to baseline.
Table 1 International League Against Epilepsy definition of status epilepticus indicates that emergency treatment of status epilepticus should be started at t 1 and long-term consequences may occur at t 2. Open in a separate window.
Epidemiology, Morbidity, and Mortality Current estimates of the incidence of status epilepticus in children vary by age. Medical Management and Stabilization Status epilepticus is a medical as well as neurologic emergency. Diagnostics Multiple studies have investigated pediatric status epilepticus etiologies, and febrile status epilepticus is the most common diagnosis [ 32 , 33 , 34 ].
Management of Status Epilepticus Administration of appropriate anti-seizure medications should occur as the patient is medically stabilized and diagnostic studies are performed. IV contains propylene glycol. Diazepam IV: 0. Midazolam Adult IM: 0.
Fosphenytoin is compatible in saline, dextrose, and lactated ringers solutions. Management of Refractory Status Epilepticus Refractory status epilepticus is characterized by seizures that persist despite treatment with adequate doses of initial anti-seizure medications. Conclusions Status epilepticus is a common neurologic emergency in children.
Conflicts of Interest The authors declare no conflict of interest. References 1. Chin R. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: Prospective population-based study. Roger J.
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