Status epilepticus in the pediatric ICU: state of the art.
Status epilepticus in the pediatric intensive care setting is a neurological emergency. Its management presents profound challenges for the pediatric intensivist, and neurologist. Understanding the neurobiological factors that are operative in transition of an epileptic seizure to self-sustained status epilepticus is critical to management. Statue epilepticus in children is often heterogeneous in etiology. In this article, I examine the evidence for who is likely to be admitted to the pediatric intensive care unit for management, the risk factors, the relationship of seizure duration and evolution to status epilepticus, and the reasons for seizure refractoriness. The immediate complications and long term consequences leading to morbidity and mortality in this condition are reviewed. The problem of refractory status epilepticus is particularly more frequently encountered in the intensive care setting. Therapeutic options in the initial management and in particular addressing reasons for the development of pharmacoresistance in status epilepticus are presented. Finally, data on outcome in the pediatric ICU setting is discussed providing thus an overview of our current understanding and state of the art in the management of status epilepticus in children.
Prasad
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AN
Department of Pediatrics and Clinical Neurological Sciences, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
D002648:Child; D002675:Child, Preschool; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008279:Magnetic Resonance Imaging; D012307:Risk Factors; D013226:Status Epilepticus / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome