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. 2004 Nov;75(11):1584–1588. doi: 10.1136/jnnp.2003.032797

Inappropriate emergency management of status epilepticus in children contributes to need for intensive care

R Chin 1, L Verhulst 1, B Neville 1, M Peters 1, R Scott 1
PMCID: PMC1738784  PMID: 15489391

Abstract

Objectives: To characterise the clinical features, emergency pre-paediatric intensive care (PIC) treatment, and course of status epilepticus (SE) in children admitted to PIC. This may provide insight into reasons for admission to PIC and provide a framework for the development of strategies that decrease the requirement for intensive care.

Design: Cross sectional, retrospective study.

Setting: A tertiary paediatric institution's intensive care unit.

Participants: The admission database and all discharge summaries of each admission to a tertiary paediatric institution's PIC over a three year period were searched for children aged between 29 days and 15 years with a diagnosis of SE or related diagnoses. The case notes of potential cases of SE were systematically reviewed, and clinical and demographic data extracted using a standard data collection form.

Results: Most children with SE admitted to PIC are aged less than 5 years, male to female ratio 1:1, and most (77%) will have had no previous episodes of SE. Prolonged febrile convulsions, SE related to central nervous system infection, and SE associated with epilepsy occur in similar proportions. Contrary to the Advanced Paediatric Life Support guidelines many children admitted to PIC for SE receive over two doses, or inadequate doses, of benzodiazepine. There is a risk of respiratory depression following administration of over two doses of benzodiazepine (χ2 = 3.4, p = 0.066). Children with SE admitted to PIC who had prehospital emergency treatment are more likely to receive over two doses of benzodiazepines (χ2 = 11.5, p = 0.001), and to subsequently develop respiratory insufficiency (χ2 = 6.2, p = 0.01). Mortality is low. Further study is required to determine the morbidity associated with SE in childhood requiring intensive care.

Conclusions: As the risk of respiratory depression is greater with more than two doses of benzodiazepines, clinicians should not disregard prehospital treatment of SE. As pre-PIC treatment of SE is inadequate in many cases, appropriate audit and modifications of standard guidelines are required.

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Selected References

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  1. Appleton R., Choonara I., Martland T., Phillips B., Scott R., Whitehouse W. The treatment of convulsive status epilepticus in children. The Status Epilepticus Working Party, Members of the Status Epilepticus Working Party. Arch Dis Child. 2000 Nov;83(5):415–419. doi: 10.1136/adc.83.5.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Coeytaux A., Jallon P., Galobardes B., Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000 Sep 12;55(5):693–697. doi: 10.1212/wnl.55.5.693. [DOI] [PubMed] [Google Scholar]
  3. DeLorenzo R. J., Hauser W. A., Towne A. R., Boggs J. G., Pellock J. M., Penberthy L., Garnett L., Fortner C. A., Ko D. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996 Apr;46(4):1029–1035. doi: 10.1212/wnl.46.4.1029. [DOI] [PubMed] [Google Scholar]
  4. Dunn D. W. Status epilepticus in children: etiology, clinical features, and outcome. J Child Neurol. 1988 Jul;3(3):167–173. doi: 10.1177/088307388800300303. [DOI] [PubMed] [Google Scholar]
  5. Gastaut H. Classification of status epilepticus. Adv Neurol. 1983;34:15–35. [PubMed] [Google Scholar]
  6. Hesdorffer D. C., Logroscino G., Cascino G., Annegers J. F., Hauser W. A. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology. 1998 Mar;50(3):735–741. doi: 10.1212/wnl.50.3.735. [DOI] [PubMed] [Google Scholar]
  7. Knudsen F. U. Rectal administration of diazepam in solution in the acute treatment of convulsions in infants and children. Arch Dis Child. 1979 Nov;54(11):855–857. doi: 10.1136/adc.54.11.855. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Lacroix J., Deal C., Gauthier M., Rousseau E., Farrell C. A. Admissions to a pediatric intensive care unit for status epilepticus: a 10-year experience. Crit Care Med. 1994 May;22(5):827–832. doi: 10.1097/00003246-199405000-00019. [DOI] [PubMed] [Google Scholar]
  9. Leppik I. E. Status epilepticus. Clin Ther. 1985;7(2):272–278. [PubMed] [Google Scholar]
  10. Lothman E. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990 May;40(5 Suppl 2):13–23. [PubMed] [Google Scholar]
  11. Maytal J., Shinnar S., Moshé S. L., Alvarez L. A. Low morbidity and mortality of status epilepticus in children. Pediatrics. 1989 Mar;83(3):323–331. [PubMed] [Google Scholar]
  12. Nelson K. B., Ellenberg J. H. Prognosis in children with febrile seizures. Pediatrics. 1978 May;61(5):720–727. [PubMed] [Google Scholar]
  13. Norris E., Marzouk O., Nunn A., McIntyre J., Choonara I. Respiratory depression in children receiving diazepam for acute seizures: a prospective study. Dev Med Child Neurol. 1999 May;41(5):340–343. doi: 10.1017/s0012162299000742. [DOI] [PubMed] [Google Scholar]
  14. O'Regan M. E., Brown J. K., Clarke M. Nasal rather than rectal benzodiazepines in the management of acute childhood seizures? Dev Med Child Neurol. 1996 Nov;38(11):1037–1045. doi: 10.1111/j.1469-8749.1996.tb15064.x. [DOI] [PubMed] [Google Scholar]
  15. Scholtes F. B., Renier W. O., Meinardi H. Status epilepticus in children. Seizure. 1996 Sep;5(3):177–184. doi: 10.1016/s1059-1311(96)80033-1. [DOI] [PubMed] [Google Scholar]
  16. Scott R. C., Besag F. M., Boyd S. G., Berry D., Neville B. G. Buccal absorption of midazolam: pharmacokinetics and EEG pharmacodynamics. Epilepsia. 1998 Mar;39(3):290–294. doi: 10.1111/j.1528-1157.1998.tb01375.x. [DOI] [PubMed] [Google Scholar]
  17. Scott R. C., Besag F. M., Neville B. G. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet. 1999 Feb 20;353(9153):623–626. doi: 10.1016/S0140-6736(98)06425-3. [DOI] [PubMed] [Google Scholar]
  18. Scott R. C., Neville B. G. Pharmacological management of convulsive status epilepticus in children. Dev Med Child Neurol. 1999 Mar;41(3):207–210. doi: 10.1017/s0012162299000407. [DOI] [PubMed] [Google Scholar]
  19. Stewart W. A., Harrison R., Dooley J. M. Respiratory depression in the acute management of seizures. Arch Dis Child. 2002 Sep;87(3):225–226. doi: 10.1136/adc.87.3.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Towne A. R., Pellock J. M., Ko D., DeLorenzo R. J. Determinants of mortality in status epilepticus. Epilepsia. 1994 Jan-Feb;35(1):27–34. doi: 10.1111/j.1528-1157.1994.tb02908.x. [DOI] [PubMed] [Google Scholar]

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