Table 2.

Key Recommendations of the adapted CPG for management of Convulsive Status Epilepticus (CSE) in children.

Prolonged or Repeated Seizures and CSE

1.First-Line Treatment for Children with prolonged or Repeated generalized, convulsive (Tonic–Clonic, Tonic or Clonic) Seizures in the Community

1.1. Give immediate emergency care and treatment to children who have prolonged (lasting 5 minutes or more) or repeated (three or more in an hour) convulsive seizures in the community. 1.2. Only prescribe buccal midazolam or rectal diazepam for use in the community for children who have had a previous episode of prolonged or serial convulsive seizures. 1.3. Administer buccal midazolam as first-line treatment in children and young people with prolonged or repeated seizures in the community. Administer rectal diazepam if preferred or if buccal midazolam is not available 1.3. Treatment should be administered by trained clinical personnel or, if specified by an individually agreed protocol drawn up with the specialist, by family members or carers with appropriate training. 1.4. Care must be taken to secure the child airway and assess his or her respiratory and cardiac function. 1.5. Depending on response to treatment, the person’s situation and any personalized care plan, call an ambulance, particularly if:-  1.5.1. The seizure is continuing 5 minutes after the emergency medication has been administered.  1.5.2. The person has a history of frequent episodes of serial seizures or has CSE, or this is the first episode requiring emergency treatment or  1.5.3. There are concerns or difficulties monitoring the person’s airway, breathing, circulation or other vital signs.

2.Treatment for Children with CSE in Hospital

2.1 For children and young people with ongoing generalized tonic–clonic seizures (CSE) who are in the hospital, immediately:  •Secure airway  •Give high-concentration oxygen  •Assess cardiac and respiratory function  •Check blood glucose levels and  •Secure intravenous access in a large vein 2.2 Administer intravenous lorazepam as first-line treatment in children, with ongoing generalized tonic–clonic seizures (CSE). Administer intravenous diazepam if intravenous lorazepam is unavailable, or buccal midazolam if unable to secure immediate intravenous access. Administer a maximum of two doses of the first-line treatment (including pre-hospital treatment). 2.3 If seizures continue, administer intravenous phenobarbital or phenytoin as second-line treatment in hospital in children with ongoing generalized tonic–clonic seizures (CSE).

3.Refractory CSE

3.1. Administer intravenous midazolam or thiopental sodium to treat children with refractory CSE. Adequate monitoring, including blood levels of Antiepileptic Drugs (AEDs), and critical life systems support are required. 3.2. As the treatment pathway progresses, the expertise of an anesthetist/intensivist should be sought. 3.3. Regular AEDs should be continued at optimal doses and the reasons for status epilepticus should be investigated. 3.4. An individual treatment pathway should be formulated for children who have recurrent CSE.

The recent SE definition included a seizure longer than 5 minutes or two or more seizures without a return of consciousness between seizures. Serial seizures are defined as 3 or more tonic-clonic seizures in an hour. SE can be divided into a number of subtypes, either by seizure type or response to treatment. Clinical SE can be either focal or generalized, and each of these types can be divided by duration into; (i) Early SE (5-30 minutes), (ii) Established SE (30-60 minutes), and (iii) Refractory SE (seizures persist despite treatment with adequate doses of two or three initial anticonvulsant medications)