Emergency Management of Paediatric Status Epilepticus
1Emergency Department, Royal Children';s Hospital, Australia
Convulsive status epilepticus is the most common life-threatening paediatric neurological emergency, associated with considerable morbidity and mortality. International practice guidelines recommend a staged approach with initial treatment with benzodiazepines followed by a second line agent, traditionally phenytoin or fosphenytoin. Generally, rapid sequence intubation and ICU admission is recommended if second line agents are ineffective. The evidence base for phenytoin and fosphenytoin use, however, is limited and both agents are associated with side effects. At the same time newer parenteral anticonvulsive agents, such as levetiracetam, have become available which appear to have more benign adverse events profiles with easier administration.
Three large multicentre randomised trials of convulsive status epilepticus in children have been conducted with 2 trials having completed recruitment. For one of the trials, the Convulsive Status Epilepticus Paediatric Trial (ConSEPT) comparing levetiracetam and phenytoin as second line agents, results have recently become available (The speaker is one of the investigators of ConSEPT).
This talk will present the current state of evidence on the management of convulsive status in children and lessons from the ConSEPT study and any other trial results available at the time of presentation.