Abstract
Status epilepticus (SE) is a condition characterised by frequent and prolonged epileptic seizures which frequently develop in the immature brain. Fever, metabolic disorders and subtherapeutic concentrations of antiepileptic drugs are the most common factors precipitating SE in children.
Progressive neuronal damage occurs if convulsive SE persists for more than 30 minutes, with neurological, epileptic and cognitive sequelae. Unfortunately, the immature brain is more predisposed to SE and its sequelae than the mature brain.
SE may be categorised as convulsive, nonconvulsive or neonatal according to its responsiveness to antiepileptic drugs. Regardless of category, the main objective in the treatment of SE is to abort the seizures and treat the inciting condition.
Treatment includes: (i) monitoring of hydration, electrolyte balance, and cardiocirculatory and pulmonary functions; and (ii) rapid intravenous administration of specific antiepileptic drugs.
Benzodiazepines (usually diazepam, lorazepam or midazolam) are the most effective agents for the initial treatment of convulsive and nonconvulsive SE. In particular, midazolam infusion is an effective and well tolerated therapeutic approach for the management of childhood SE, including refractory SE. Phenytoin remains an excellent agent because of its long duration of action, but it is not active in nonconvulsive SE. Fosphenytoin, a phenytoin prodrug, represents a significant advance in the treatment of children with convulsive SE. Intravenous phenytoin and intramuscular phenobarbital (phenobarbitone) are generally used in neonatal SE; other agents are rarely used.
Similar content being viewed by others
References
ILAE commission on classification and terminology of the international league against epilepsy. Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30: 389–99
Bone RC. Treatment of convulsive status epilepticus: recommendations of the epilepsy foundation of America’s working group on status epilepticus. JAMA 1993; 270(7): 854–9
Gastaut H. Classification of status epilepticus. In: Delgado-Escueta AV, Porter RJ, Wasterlain CG, editors. Status epilepticus: mechanisms of brain damage and treatment. New York (NY): Raven, 1982: 13–8
Pellock JM. Status epilepticus in children: update and review. J Child Neurol 1994; 9Suppl. 2: 2827–35
Aicardi J, Chevrie JJ. Convulsive status epilepticus in infants and children: a study of 239 cases. Epilepsia 1970; 11: 187–97
Hauser WA. Status epilepticus: epidemiologic considerations. Neurology 1990; 40 (5 Suppl. 2): 13–22
Aminoff MJ, Simon RP. Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med 1980; 69: 657–66
Yager JY, Cheang M, Seshia SS. Status epilepticus in children. Can J Neurol Sci 1988; 15: 402–5
Phillips SA, Shanahan RJ. Etiology and mortality of status epilepticus in children: a recent update. Arch Neurol 1989; 46: 74–6
Lothman EW. The biochemical basis and pathophysiology of status epilepticus. Neurology 1990; 40 (5 Suppl. 2): 13–23
Wasterlain CG, Fujikawa DG, Penix LR, et al. Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia 1993; 34Suppl. 1: S37–53
Moshé SL. Seizures in the developing brain. Neurology 1993; 43 (11 Suppl. 5): S3–7
Fountain NB, Lothman EW. Pathophysiology of status epilepticus. J Clin Neurophysiol 1995; 12(4): 326–42
Hauser WA. Status epilepticus: frequency, etiology and neurological sequelae. In: Delgado-Escueta AV, Wasterlain CG, Treiman DG, et al., editors. Status epilepticus (Advances in Neurology. Vol. 34). New York (NY): Raven Press, 1983: 3–14
Lothman EW, Bertram III EH. Epileptogenic effects of status epilepticus. Epilepsia 1993; 34Suppl. 1: S59–70
Wasterlain CG, Shirasaka Y. Seizures, brain damage and brain development. Brain Dev 1994; 16: 279–95
Lockman LA. Treatment of status epilepticus in children. Neurology 1990; 40 (5 Suppl. 2): 43–6
Ramsay RE. Treatment of status epilepticus. Epilepsia 1993; 34Suppl. 1: S71–81
Matthes JWA, Wallace SJ. Convulsive status epilepticus in children treated for epilepsy: an assessment of management. Dev Med Child Neurol 1995; 37: 226–31
Haafiz A, Kissoon N. Status epilepticus: current concepts. Pediatr Emerg Care 1999; 15(2): 119–29
McDonald RE, McLean MJ. Anticonvulsant drugs: mechanisms of action. In: Delgado-Escueta AV, Ward Jr AA, Woodbury DM, et al., editors. Basic mechanisms of the epilepsies: molecular and cellular approaches (Advances in Neurology. Vol. 44). New York (NY): Raven Press, 1986; 115–25
Shaner DM, McCurdy SA, Herring MO, et al. Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology 1988; 38: 202–7
Browne TR. The pharmacokinetics of agents used to treat status epilepticus. Neurology 1990; 40 (5 Suppl. 2): 28–31
Magnussen I, Oxlund HRW, Alsbirk KE, et al. Absorption of diazepam in man following rectal and parenteral administration. Acta Pharmacol Toxicol 1979; 45: 88–90
Albano A, Reisdorff EJ, Wiegenstein JP. Rectal diazepam in pediatric status epilepticus. Am J Emerg Med 1988; 70: 168–72
Graves NM, Kriel RL. Rectal administration of antiepileptic drugs in children. Pediatr Neurol 1987; 3: 321–6
Treiman DM. The role of benzodiazepines in the management of status epilepticus. Neurology 1990; 40 (5 Suppl. 2): 32–42
Scott RC, Neville BGR. Pharmacological management of convulsive status epilepticus in children. Dev Med Child Neurol 1999; 41: 207–10
Lal Koul R, Aithale G, Chacko A, et al. Continuous midazolam infusion as treatment of status epilepticus. Arch Dis Child 1997; 76(5): 445–8
Kondall JL, Reynolds M, Goldberg R. Intranasal midazolam in patients with status epilepticus. Ann Emerg Med 1997; 29(3): 415–7
Crawford TO, Mitchell WG, Fishman LS, et al. Very high dose phenobarbital for refractory status epilepticus in children. Neurology 1988; 38: 1035–40
Cranford RE, Leppik IE, Patrick B, et al. Intravenous phenytoin in acute treatment of seizures. Neurology 1979; 29: 1474–9
Pellock JM. Fosphenytoin use in children. Neurology 1996; 46 (6 Suppl. 1): S14–6
Czapinski P, Terczynoski A. Intravenous valproic acid administration in status epilepticus. Neurol Neurochir Pol 1998; 32(1): 11–22
Snead III OC, Miles MV. Treatment of status epilepticus in children with rectal sodium valproate. J Pediatr 1985; 106: 323–5
Browne TR. Paraldehyde, chlormethozale and lidocaine for treatment of status epilepticus. Adv Neurol 1983; 34: 509–15
Curless R, Holtzman B, Ramsay RE. Paraldehyde therapy in childhood status epilepticus. Arch Neurol 1983; 40: 477–80
Eriksson KL, Koivikko MJ. Status epilepticus in children: aetiology, treatment and outcome. Dev Med Child Neurol 1997; 39: 652–8
Borgeat A. Propofol: pro- or anticonvulsant?. Eur J Suppl Anaesthesiol 1997; 15: 17–22
Cascino G. Non convulsive status epilepticus in adults and children. Epilepsia 1993; 34Suppl. 1: S21–8
De Negri M, Baglietto MG, Battaglia FM, et al. Treatment of electrical status epilepticus by short diazepam (DZP) cycles after DZP rectal bolus test. Brain Dev 1995; 17: 330–3
De Negri M. Electrical status epilepticus in childhood: neuropsychological impairment and therapeutic management. Dev Med Child Neurol 1994; 36: 192–5
De Negri M. Electrical status epilepticus during sleep (ESE): different clinical syndromes: towards a unifying view? Brain Dev 1997; 19: 447–51
Patry S, Lyagoubi S, Tassinari CA. Subclinical electrical status epilepticus induced by sleep in children. Arch Neurol 1971; 24: 242–52
Landau WM, Kleffner FR. Syndrome of acquired aphasia with convulsive disorder in children. Neurology 1957; 7: 523–30
Beaussart M. Benign epilepsy of children with rolandic (centropiramidal) paroxysmal foci. Epilepsia 1972; 14: 342–5
Kaplan PW. Intravenous valproate treatment of generalized nonconvulsive status epilepticus. Clin Electroencephalogr 1999; 30(1): 1–4
Dreyfus-Brisac C, Monod N. Neonatal status epilepticus. In: Rémond A, editor. Neonatal status epilepticus. Vol. 15, Part B. Amsterdam: Elsevier, 1977: 39–52
Cukier F, Sfaello L, Dreyfus-Brisac C. Les états de mal du nouveau né dans un centre de réanimation néonatale. Gaslini 1976; 8: 100–6
Gilly R, Revol M, Dutruye J. et al. Convulsions et états de mal du nouveau-né. Lyon Med 1973; 229: 357–66
Lombroso CT. Differentiation of seizures in newborn and early infancy. In: Morselli PL, Pippenger CE, Penry JK, editors. Antiepileptic drug therapy in pediatrics. New York (NY): Raven Press, 1983; 85–102
Treiman DM. Electroclinical features of status epilepticus. J Clin Neurophysiol 1995; 12(4): 343–62
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
De Negri, M., Baglietto, M.G. Treatment of Status Epilepticus in Children. Paediatr Drugs 3, 411–420 (2001). https://doi.org/10.2165/00128072-200103060-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00128072-200103060-00002