Anest. intenziv. Med. 2018;29(3):139-147

Management of convulsive status epilepticus in childrenReview Article

Š. Aulická¹, P. Aulický², K. Česká¹, K. Španělová¹, H. Ošlejšková^1,*

¹ Klinika dětské neurologie, Lékařská fakulta, Masarykova univerzita, Fakultní nemocnice Brno

² Oddělení anesteziologie, resuscitace a intenzivní medicíny, Nemocnice Milosrdných bratří

Generalized convulsive status epilepticus (GCSE) is the most common neurological emergency in children. It is defined as a generalized convulsive seizure lasting longer than 5 minutes. The infantile and particularly neonatal period is the high-risk period for development of GCSE. The most common etiology is febrile status epilepticus. GCSE is divided into four stages: early (5-20 minutes), established (20-40 minutes), refractory (>40 minutes), and super-refractory (>24 hours). A generalized convulsive seizure lasting up to 5 minutes is called impending GCSE. This corresponds with the time in which adequate seizure termination treatment should be initiated.
Management of GCSE consists of basic life support (the ABC) and administration of antiepileptic drugs which will stop the seizure. Identification and treatment of the cause of the status is equally important. All antiepileptic drugs should be administrated intravenously. First line treatment of early-stage GCSE includes benzodiazepines (diazepam or clonazepam). Second line treatment of established GCSE includes one of the non-benzodiazepine antiepileptic drugs: phenytoin, valproate, levetiracetam, phenobarbital or lacosamide. In the case of failure of first-line and second-line treatment, i.e. in the refractory GCSE stage, IV anaesthetic drugs (thiopental, midazolam, or propofol) are commonly used. General anaesthesia should be maintained for 24 to 48 hours and the depth of the anaesthetic coma should be monitored by continuous EEG. When treatment with IV anaesthesia for more than 24 hours is unsuccessful in controlling the GCSE, the condition can be termed super-refractory GCSE. This condition is associated with high morbidity and mortality.

Keywords: convulsive status epilepticus; refractory status epilepticus; children

Received: February 12, 2018; Accepted: April 22, 2018; Published: June 1, 2018  Show citation