title: Medical management with diazepam for electrical status epilepticus during slow wave sleep in children.
abstract: OBJECTIVE
  Oral diazepam, administered in varying doses, is among the few proposed treatment options for electrical status epilepticus during slow wave sleep in children. We sought to retrospectively evaluate the long-term efficacy of high-dose oral diazepam in reducing electrographic and clinical evidence of electrical status epilepticus during slow wave sleep in children. Additionally, we surveyed caregivers to assess safety and behavioral outcomes related to ongoing therapy.
  
  
  METHODS
  We collected demographic and clinical data on children treated for electrical status epilepticus during slow wave sleep between October 2010 and March 2013. We sought to identify the number of patients who achieved at least a 50% reduction in spike wave index on electroencephalograph after receiving high-dose oral diazepam. We also administered a questionnaire to caregivers to assess for behavioral problems and side effects.
  
  
  RESULTS
  We identified 42 evaluable patients who received high-dose diazepam (range 0.23-2.02 mg/kg per day) to treat electrical status epilepticus during slow wave sleep. Twenty-six patients had spike reduction data and 18/26 (69.2%) children achieved a greater than 50% reduction in spike wave count from an average of 15.54 to 5.05 (P = 0.001). We received 28 responses to the questionnaire. Some patients experienced new onset of difficulties with problem-solving and speech and writing development. Sleep disturbances (50%) and irritability (57.1%) were the most frequent side effects reported. There did not appear to be a dose-related effect with electroencephalograph changes, behavioral effects, or side effects.
  
  
  CONCLUSIONS
  High-dose oral diazepam significantly reduces the spike wave count on electroencephalograph in children with electrical status epilepticus during slow wave sleep. Although this therapy improves electroencephalograph-related findings, it can be associated with concerning neurological and behavioral side effects in some individuals, so further study is warranted.
authors.affiliation: Upstate Golisano Children's Hospital, Upstate Medical University, Syracuse, NY. Electronic address: francoid@upstate.edu.
authors.forename: Densley
authors.initials: D
authors.lastname: Francois
authors.affiliation: Upstate Golisano Children's Hospital, Upstate Medical University, Syracuse, NY.
authors.forename: Jessica
authors.initials: J
authors.lastname: Roberts
authors.affiliation: Upstate Golisano Children's Hospital, Upstate Medical University, Syracuse, NY.
authors.forename: Stephany
authors.initials: S
authors.lastname: Hess
authors.affiliation: Upstate Golisano Children's Hospital, Upstate Medical University, Syracuse, NY.
authors.forename: Luke
authors.initials: L
authors.lastname: Probst
authors.affiliation: Upstate Golisano Children's Hospital, Upstate Medical University, Syracuse, NY.
authors.forename: Yaman
authors.initials: Y
authors.lastname: Eksioglu
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003975:Diazepam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012890:Sleep / Q000187:drug effects* / Q000502:physiology; D013226:Status Epilepticus / Q000188:drug therapy* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D003975:Diazepam
keywords: children; diazepam; electrical status epilepticus during slow wave sleep; seizure; status epilepticus