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Treatment of pediatric convulsive status epilepticus

Status epilepticus is one of the most common life-threatening neurological emergencies in childhood with the highest incidence in the first 5 years of life and high mortality and morbidity rates. Although it is known that a delayed treatment and a prolonged seizure can cause permanent brain damage,...

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Autores principales: Becker, Lena-Luise, Gratopp, Alexander, Prager, Christine, Elger, Christian E., Kaindl, Angela M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10343462/
https://www.ncbi.nlm.nih.gov/pubmed/37456627
http://dx.doi.org/10.3389/fneur.2023.1175370
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author Becker, Lena-Luise
Gratopp, Alexander
Prager, Christine
Elger, Christian E.
Kaindl, Angela M.
author_facet Becker, Lena-Luise
Gratopp, Alexander
Prager, Christine
Elger, Christian E.
Kaindl, Angela M.
author_sort Becker, Lena-Luise
collection PubMed
description Status epilepticus is one of the most common life-threatening neurological emergencies in childhood with the highest incidence in the first 5 years of life and high mortality and morbidity rates. Although it is known that a delayed treatment and a prolonged seizure can cause permanent brain damage, there is evidence that current treatments may be delayed and the medication doses administered are insufficient. Here, we summarize current knowledge on treatment of convulsive status epilepticus in childhood and propose a treatment algorithm. We performed a structured literature search via PubMed and ClinicalTrails.org and identified 35 prospective and retrospective studies on children <18 years comparing two and more treatment options for status epilepticus. The studies were divided into the commonly used treatment phases. As a first-line treatment, benzodiazepines buccal/rectal/intramuscular/intravenous are recommended. For status epilepticus treated with benzodiazepine refractory, no superiority of fosphenytoin, levetirazetam, or phenobarbital was identified. There is limited data on third-line treatments for refractory status epilepticus lasting >30 min. Our proposed treatment algorithm, especially for children with SE, is for in and out-of-hospital onset aids to promote the establishment and distribution of guidelines to address the treatment delay aggressively and to reduce putative permanent neuronal damage. Further studies are needed to evaluate if these algorithms decrease long-term damage and how to treat refractory status epilepticus lasting >30 min.
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spelling pubmed-103434622023-07-14 Treatment of pediatric convulsive status epilepticus Becker, Lena-Luise Gratopp, Alexander Prager, Christine Elger, Christian E. Kaindl, Angela M. Front Neurol Neurology Status epilepticus is one of the most common life-threatening neurological emergencies in childhood with the highest incidence in the first 5 years of life and high mortality and morbidity rates. Although it is known that a delayed treatment and a prolonged seizure can cause permanent brain damage, there is evidence that current treatments may be delayed and the medication doses administered are insufficient. Here, we summarize current knowledge on treatment of convulsive status epilepticus in childhood and propose a treatment algorithm. We performed a structured literature search via PubMed and ClinicalTrails.org and identified 35 prospective and retrospective studies on children <18 years comparing two and more treatment options for status epilepticus. The studies were divided into the commonly used treatment phases. As a first-line treatment, benzodiazepines buccal/rectal/intramuscular/intravenous are recommended. For status epilepticus treated with benzodiazepine refractory, no superiority of fosphenytoin, levetirazetam, or phenobarbital was identified. There is limited data on third-line treatments for refractory status epilepticus lasting >30 min. Our proposed treatment algorithm, especially for children with SE, is for in and out-of-hospital onset aids to promote the establishment and distribution of guidelines to address the treatment delay aggressively and to reduce putative permanent neuronal damage. Further studies are needed to evaluate if these algorithms decrease long-term damage and how to treat refractory status epilepticus lasting >30 min. Frontiers Media S.A. 2023-06-29 /pmc/articles/PMC10343462/ /pubmed/37456627 http://dx.doi.org/10.3389/fneur.2023.1175370 Text en Copyright © 2023 Becker, Gratopp, Prager, Elger and Kaindl. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Becker, Lena-Luise
Gratopp, Alexander
Prager, Christine
Elger, Christian E.
Kaindl, Angela M.
Treatment of pediatric convulsive status epilepticus
title Treatment of pediatric convulsive status epilepticus
title_full Treatment of pediatric convulsive status epilepticus
title_fullStr Treatment of pediatric convulsive status epilepticus
title_full_unstemmed Treatment of pediatric convulsive status epilepticus
title_short Treatment of pediatric convulsive status epilepticus
title_sort treatment of pediatric convulsive status epilepticus
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10343462/
https://www.ncbi.nlm.nih.gov/pubmed/37456627
http://dx.doi.org/10.3389/fneur.2023.1175370
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