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Status epilepticus in paediatrics: a retrospective study and review of the literature

E.E. Moreno-Medinilla, R. Negrillo-Ruano, R. Calvo-Medina, M.D. Mora-Ramírez, J.L. Martínez-Antón [REV NEUROL 2015;60:394-400] PMID: 25912700 DOI: https://doi.org/10.33588/rn.6009.2015028

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Volumen 60 | Number 09 | Nº of views of the article 7.485 | Nº of PDF downloads 1.663 | Article publication date 01/05/2015

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ABSTRACT

INTRODUCTION Status epilepticus (SE) is the most common neurological emergency on pediatric. Given the possibility of neurological sequelae and mortality associated, it requires an early aggressive treatment.

PATIENTS AND METHODS Retrospective descriptive study based on the review of medical histories of patients admitted to our hospital from 2010 to 2013 with a diagnosis of SE. The objective was to describe the epidemiology characteristics and the management of these patients, and to review the available literature on this topic.

RESULTS We collected 39 patients (25 males) and 51 episodes of SE. Average age: 4.8 years. Twenty-two patients had an underlying disease, 18 were known epileptic and 5 had a previous SE. With a total of 51 SE, 33 were symptomatic, 15 were febrile and 3 were cryptogenic. Types of SE: 25 were partial (16 of them complex) and 26 were generalized. Treatment: 47 benzodiazepines as treatment of choice (40 diazepam), 3 phenytoin and 1 valproic acid. Twenty-seven patients required second-line drugs: 16 valproic acid, 8 phenytoin, 2 phenobarbital and 1 levetiracetam. Ten patients required third-line drugs for the induction of barbiturate-induced coma: midazolam was the most used in our center, followed by thiopental and propofol. Two super-refractory SE required immunoglobulins and systemic corticosteroids for appearing on the course of autoimmune encephalitis.

CONCLUSIONS The therapeutic scheme of SE should be considered since the start of any seizure. The treatment is staggered with benzodiazepines in the first stage, broad spectrum antiepileptic drugs, and intravenous availability in the second (valproic acid, levetiracetam in the generalized SE and phenytoin in the focal), while the third level varies depending on the experience of each team. KeywordsAntiepileptic drug Benzodiazepines Drug resistance Epilepsy Seizure Status epilepticus Treatment CategoriesEpilepsias y síndromes epilépticos Neuropediatría Técnicas exploratorias

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Original

Status epilepticus in paediatrics: a retrospective study and review of the literature