title: Management of acute seizure and status epilepticus in pediatric emergency.
abstract: Acute seizure and status epilepticus constitute one of the major medical emergencies in children. Among children, the incidence ranges from 4-38/100,000 children per year respectively. The incidence in developing countries is somewhat higher because of infections. Although, the definition of status epilepticus is based on duration of seizures, the operational definition is to treat any child who is brought seizing to the emergency room, as status epilepticus. An urgent time bound approach is of paramount importance when managing a child in status epilepticus. Benzodiazepines remain the first line antiepileptic drugs in the emergency room; a long acting drug (Lorazepam) is preferred when available. This is followed by Phenytoin (20 mg/kg) loading. In patients refractory to above drugs, valproate (30 mg/kg) loading is commonly used and if effective, followed by an infusion (5 mg/kg/h) for seizure free period of 6 h. In non-responders, a trial of Levetiracetam (40 mg/kg infused at 5 mg/kg/min) can be used before starting benzodiazepine or thiopental coma (3-4 mg/kg loading dose, followed by 2 mg/kg/min infusion). When pharmacological coma is initiated, the child needs to be shifted to pediatric intensive care unit for proper monitoring and titration of medications.
authors: Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh 160 012, India.
authors: K
authors: K
authors: Sasidaran
authors: Sunit
authors: S
authors: Singhi
authors: Pratibha
authors: P
authors: Singhi
mesh_terms: D000771:Anesthesia, Intravenous; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004305:Dose-Response Relationship, Drug; D004636:Emergency Service, Hospital; D004827:Epilepsy / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007194:India; D007223:Infant; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D000077287:Levetiracetam; D008140:Lorazepam / Q000009:adverse effects / Q000627:therapeutic use; D010672:Phenytoin / Q000009:adverse effects / Q000627:therapeutic use; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D013874:Thiopental; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines; D000077287:Levetiracetam; D014635:Valproic Acid; D010672:Phenytoin; D013874:Thiopental; D008140:Lorazepam; D010889:Piracetam