title: Convulsive status epilepticus in children: etiology, treatment protocol and outcome.
abstract: This study aimed to determine the etiology, treatment protocol and outcome of convulsive status epilepticus (SE) in children. An institutional treatment protocol using benzodiazepines (diazepam and midazolam) was assessed in a retrospective case study. The treatment protocol (Ege Pediatric Status Epilepticus Protocol or EPSEP) was developed based on an operational definition of pediatric SE according to the duration of seizure activity. Pediatric SE is divided into three categories: initial SE (20-30 min), established SE (30-60 min) and refractory SE (>60 min). Eight (30%) of the studied episodes were initial SE, 10 (37%) were established SE, and 9 (33%) were refractory SE. With respect to the etiological spectrum of SE, 11 (40%) children had meningitis or encephalitis. Febrile SE was identified in 7 (26%) patients. Only 2 episodes of initial SE (7.5%) were controlled with first step of the protocol (two concomitant-doses of rectal diazepam). Midazolam bolus and infusions (up to 1.2 μg/kg/min) were used to treat 22 episodes of SE (9 refractory SE, 10 established SE and 3 initial SE). Complete arrest of convulsive SE was achieved in 21 of 22 (95%) episodes with midazolam infusion. We concluded that the combined use of benzodiazepines (diazepam+midazolam) was safe and effective in the treatment of convulsive SE in children.
authors.affiliation: Pediatric Emergency Department, Ege University School of Medicine, 35100 Bornova, Izmir, Turkey.
authors.forename: Eylem Ulas
authors.initials: EU
authors.lastname: Saz
authors.forename: Bulent
authors.initials: B
authors.lastname: Karapinar
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozcetin
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Polat
authors.forename: Ayse
authors.initials: A
authors.lastname: Tosun
authors.forename: Gul
authors.initials: G
authors.lastname: Serdaroglu
authors.forename: Sarenur
authors.initials: S
authors.lastname: Gokben
authors.forename: Hasan
authors.initials: H
authors.lastname: Tekgul
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000627:therapeutic use; D004660:Encephalitis / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008581:Meningitis / Q000150:complications; D008874:Midazolam / Q000627:therapeutic use; D012189:Retrospective Studies; D003294:Seizures, Febrile / Q000188:drug therapy; D013226:Status Epilepticus / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D003975:Diazepam; D008874:Midazolam