Treatment of status epilepticus in children.
SE is a common neurologic emergency in children. The majority of children who present in SE have no history of epilepsy. Although the clinical outcome of SE depends on the etiology of the seizure to a great extent, timely and appropriate treatment significantly reduces morbidity and mortality. SE signifies severe central nervous system dysfunction. Initial management is directed at stabilization of vital functions and a simultaneous quick but thorough investigation for an etiology. A standardized treatment protocol is essential and reduces the morbidity and mortality associated with SE. Inadequate treatment regimens and failure to recognize adverse physiological consequences of SE, such as hypoxia, hypotension, hyperthermia, and hypoglycemia, are common treatment errors. The treatment strategy for SE should ensure adequate cardiorespiratory function, stop clinical and electrical seizure activity, prevent recurrence of seizures, and identify and, if possible, treat the etiology. Achieving these four goals will improve the outcome of SE in all children. Future drug trials may also consider concurrent treatment with AEDs, which prevent the later development of epilepsy. In addition, neuroprotectants to protect against cell injury, lowering the morbidity and mortality associated with SE, and medications or rehabilitation strategies to improve the morbidity of SE after hospital discharge should also be studied.
Wheless
James W
JW
University of Texas, Houston, USA.
D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004632:Emergency Medical Services / Q000379:methods; D006760:Hospitalization; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use; D008874:Midazolam / Q000627:therapeutic use; D010372:Pediatrics / Q000379:methods* / Q000592:standards; D010672:Phenytoin / Q000031:analogs & derivatives / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012008:Recurrence; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000927:Anticonvulsants; D010672:Phenytoin; C043114:fosphenytoin; D008140:Lorazepam; D003975:Diazepam; D008874:Midazolam