Pediatric status epilepticus: improved management with new drug therapies?

ABSTRACT

Introduction: Status Epilepticus (SE) is the most common neurological emergency of childhood. It requires prompt administration of appropriately selected anti-seizure medications.

Areas covered: Following a distinction between estabilished and emergent drugs, we present pharmacological treatment options and their clinical utility in children, with a short mention on alternatives to drug treatment. We also propose an algorithm for the management of pediatric SE. For this review a Pubmed, Medline and Embase search was performed.

Expert opinion: In early SE in children, in the prehospital setting, rectal diazepam or buccal midazolam are efficacious drugs; whereas in the hospital setting, intravenous lorazepam or diazepam are indicated. As regard estabilished stage of SE, in addition to the ‘classic’ compounds, such as phenytoin and phenobarbital, other drugs such as valproic acid, levetiracetam and lacosamide have been demonstrated efficacious. Treatment recommendations of refractory SE depend on retrospective case series and uncontrolled studies. We reported experiences about the use of midazolam, propofol, ketamine and lidocaine. They could be a valid option, but further prospective studies are necessary. Over the last few decades, important advances in basic mechanisms underlying refractory SE have been achieved, but few data are available regarding management of these stages.

KEYWORDS:

• Antiepileptic drugs
• children
• management
• status epilepticus

Article highlights

• Status Epilepticus is the most common neurological emergency of childhood.

• Some pharmacological treatment options are recommended, alternative drugs or routes of administration have been explored in RCTs with enocouraging results.

• Benzodiazepines remain the cornerstone of the treatment of early status epilepticus.

• Valproic acid, Levetiracetam and Lacosamide seems to provide encouraging results for the treatment of estabilished status epilepticus in hospital setting.

• In refractory status epilepticus the choice of anticonvulsivant drugs is still question of debate and is based on case series and uncontrolled studies.

• Important advances in basic mechanisms underlying refractory status epilepticus, such as inflammation, have been achieved.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.