Pediatria pre prax 5/2023

Convulsive status epilepticus in children – management and treatment

Convulsive status epilepticus (SE) is a neurological emergency associated with high morbidity and mortality, with fever and infections as the most common causes in children. A new definition of SE published in 2017 emphasizes two specific times. Time point 1 (t1) is the time when it is necessary to start antiseizure treatment. Time point 2 (t2) is the time when long-term consequences can arise. These time points depend on type and character of the seizure. Therefore, it is very important to identify possible treatable causes, determine the type of SE and initiate treatment in appropriate doses. Administration of benzodiazepines is indicated in the first line of treatment. In Slovak Republic we can choose between diazepam and midazolam in various forms. In the second line intravenous antiseizure medications (levetiracetam, valproate, phenobarbital, phenytoin or lacosamide) should be administered and in the third line continuous anesthetics (midazolam, propofol or thiopental) are recommended. The aim of this article is to review recent recommendations in management and treatment of convulsive SE.

Keywords: status epilepticus, seizure, antiseizure medication, benzodiazepines, management