Childhood convulsive status epilepticus: epidemiology, management and outcome.
Convulsive status epilepticus (CSE) in childhood is a medical emergency and its aetiology and outcome mean that it should be studied separately from adult CSE. The incidence in developed countries is between 17 and 23/100,000 with a higher incidence in younger children. Febrile CSE is the commonest single group with a good prognosis in sharp distinction to CSE related to central nervous system infections which have a high mortality. The aim of treatment is to intervene at 5 min and studies indicate that intravenous (i.v.) lorazepam may be a better first-line treatment than rectal diazepam and i.v. phenytoin a better second-line treatment than rectal paraldehyde. An epidemiological study strongly supports the development of prehospital treatment with buccal midazolam becoming a widely used but unlicensed option in the community. More than two doses of benzodiazepines increase the rate of respiratory depression without obvious benefit. The 1 year recurrence rate is 17% and the hospital mortality is about 3%.
Neville
B G R
BG
Neurosciences Unit, University College, Institute of Child Health, and Great Ormond Street Hospital for Children, NHS Trust, London, UK. b.neville@ich.ucl.ac.uk
Chin
R F M
RF
Scott
R C
RC
D017668:Age of Onset; D001569:Benzodiazepines / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends; D004660:Encephalitis / Q000150:complications / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D012008:Recurrence; D003294:Seizures, Febrile / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D013997:Time Factors