Clinical Characteristics and Treatment Strategies in Refractory Convulsive Status Epilepticus in Children: Results from the Pediatric Status Epilepticus Research Group (pSERG) (P03.012)

Abstract

OBJECTIVE: To describe the clinical characteristics and treatment approach of refractory convulsive status epilepticus (RCSE) in children.

BACKGROUND: There is insufficient literature on the different treatment regimens for pediatric RCSE.

DESIGN/METHODS: We performed a prospective multicenter study and enrolled children with RCSE from 7 different reference hospitals in the United States from June 2011 to September 2012, inclusive. We included all patients with: 1) Status epilepticus (SE) with a convulsive onset, 2) age 30 days to 21 years, and 3) Refractory to, at least, 2 different antiepileptic drugs (AEDs) (benzodiazepines not administered as a continuous infusion was one medication), or required at least one continuous infusion of AEDs.

RESULTS: Forty patients (23 males) ranging in age from 0.2 to 17.7 (median: 2.6) years met our inclusion criteria. At onset, the CSE was continuous (35%) or intermittent seizures without return to baseline (60%). Baseline medical conditions were developmental delay (42.5%), epilepsy (37.5%), prior episode of SE (20%) and cerebral palsy (7.5%). The etiology of SE was structural (22.5%), metabolic (12.5%), genetic (7.5%) and unknown (57.5%). The median (interquartile range) time in minutes from seizure onset to: 1) first AEDs was 17.5 (5-65.3) 2) first non-benzodiazepine was 60 (30-112.5), 3) second non-benzodiazepine was 96 (75.5-322.5), and 4) end of the convulsive status epilepticus was 120 (71.3-207). The AEDs were: 1) first: lorazepam (40.4%), diazepam (19.2%), midazolam (11.5%); 2) first non-benzodiazepine: fosphenytoin (38.5%), phenytoin (17.3%), levetiracetam (5.8%), phenobarbital (3.8%), valproate (1.9%); 3) second non-benzodiazepine: phenobarbital (34.6%), fosphenytoin (9.6%), levetiracetam (9.6%), phenytoin (3.8%), valproate (3.8%). Continuous infusions were used in 14 patients: midazolam (12), pentobarbital (1), and propofol (1). Three patients required a second infusion with midazolam (2) and pentobarbital (1).

CONCLUSIONS: In our series, RCSE was more frequently intermittent, and of undetermined etiology. Although AEDs used followed published guidelines, the period between administration of benzodiazepines and non-benzodiazepines was prolonged.

Supported by: Epilepsy Foundation of America.

Disclosure: Dr. Sánchez Fernández has nothing to disclose. Dr. Abend has nothing to disclose. Dr. Agadi has nothing to disclose. Dr. An has nothing to disclose. Dr. Arya has nothing to disclose. Dr. Carpenter has nothing to disclose. Dr. Chapman has nothing to disclose. Dr. Gaillard has received personal compensation for activities with King Pharmaceutical as a participant on an advisory board. Dr. Gaillard has received research support from Questcor. Dr. Glauser has received personal compensation for activities with Questcor Pharmaceuticals, Inc., Lundbeck Research USA, Sunovion, Supernus Pharmaceuticals, Eisai, Inc., and Upsher-Smith Laboratories as a consultant and/or speaker. Dr. Glauser has received patent payments from AssureRx. Dr. Goodkin has nothing to disclose. Dr. Mikati has nothing to disclose. Dr. Peariso has nothing to disclose. Dr. Ramgopal has nothing to disclose. Dr. Ream has nothing to disclose. Dr. Loddenkemper has received personal compensation in an editorial capacity for European Journal of Epilepsy. Dr. Loddenkemper has received research support from the National Institutes of Health/NINDS, Harvard Medical School and Boston Children's Hospital.