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Treatment of convulsive status epilepticus in children

Treatment of convulsive status epilepticus in children. Danique Vlaskamp, medical student Prof. Dr. O.F. Brouwer Dr. P.M.C. Callenbach . Introduction. Convulsive status epilepticus (CSE) A single prolonged seizure or two or more seizures without complete

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Treatment of convulsive status epilepticus in children

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  1. Treatment of convulsive status epilepticus in children Danique Vlaskamp, medical student Prof. Dr. O.F. Brouwer Dr. P.M.C. Callenbach

  2. Introduction Convulsive status epilepticus (CSE) A single prolonged seizure or two or more seizures without complete recovery of consciousness in between, both lasting for at least 30 minutes and accompanied by motor components • Time period of 5-10 minutes is recommended • Annual incidence: 10-73 episodes/100.000 children (USA) • High mortality (2.7-5.2%) and morbidity (<15%) • Longer duration associated with poor outcome • Treatment • Early start • Adequate according to treatment protocol International League Against Epilepsy. Epilepsia 1993 Novorol CL. Arch Dis Child 2007 Chin RF. Lancet 2006 Lowenstein. Epilepsia 1999 Raspall-Chaure M. Lancet Neurol 2006

  3. Aims of the study First • To evaluate the treatment of CSE in childhood, including the order and timing of therapies Second • To compare this clinical practice with Dutch treatment guidelines

  4. Materials and methods Definition of CSE: traditional criteria, duration >10 minutes. • Inclusion • Between January 2000 and October 2012 • In children aged > 1 month • Treatment in UMCG • Retrospective, medical-file study: children, CSE, treatment • Dutch treatment guidelines for CSE from 2005 and 2012. Waardenburg van DA et al. Richtlijn status epilepticus kinderen ouder dan één maand. NVN en Nederlandse Liga tegen Epilepsie 2005. Kruiff de CC et al. Epileptische aanvallen / status epilepticus, leeftijd > 1 maand. Richtlijn voor de opvang in het 1e uur. NVK; 2012.

  5. Results • 269 CSE in 69 children • 67 children subsequent CSE • 49% of CSE lasted between 10-30 min • Timing of administration • Individualized treatment protocols associated with shorter total duration (p=0.002) 10-30 1.0 (0-4) 30-60 1.0 (0-6)

  6. Results Order of treatment and comparison with protocols

  7. Discussion and conclusions • Clinical practice UMCG in accordance with Dutch protocol • First choice: midazolam proven more effective • Second choice: clonazepam not recommended • Timing of treatment was not aggressive • Individualized treatment protocols improve outcome Pinder RM. Drugs 1976 Mpmbaza A. Pediatrics 2008 Scott RC. Lancet 1999 Appleton R. Cochrane Database Syst Rev 2008 Wilson MT. Arch Dis Child 2004 Chin RF Lancet Neurol 2008 McIntyre J. Lancet 2005. Sofou K J Child Neurol 2009

  8. Future perspectives • Midazolam as first treatment choice • Reconsider the use of clonazepam in the UMCG • Use of protocols stressed to parents, teachers and other involved people • Order of therapies • Frequency of administration

  9. Any questions?

  10. Results Patientcharacteristics

  11. ResultsCourse of CSE and its treatment

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