Abstracts

Rationale: Aggressive and early treatment of convulsive status epilepticus (CSE) is crucial for seizure abortion and prevention of long-term neurologic sequelae. However, data strongly suggests that the time from seizure onset to anti-seizure medication (ASM) administration is delayed. We propose the creation of an electronic seizure action plan with individualized CSE and seizure cluster medication algorithms to improve timeliness of ASM delivery and ultimately outcomes in CSE. Methods: A prospective observational cohort study of patient care processes and outcomes 18 months before and after initiation of a seizure action plan is currently ongoing. Children aged 1 month to 21 years with CSE (defined as a single seizure lasting 5 minutes or longer) or a seizure cluster (defined as 2 or more seizures in 6 hours) admitted to a tertiary pediatric hospital requiring an ASM(s) for abortion are eligible for inclusion. Exclusion criteria include infantile spasms, episodes of non-convulsive status epilepticus, and seizures resolving without ASM use. Results: Twenty-eight episodes (17 patients) of CSE or seizure cluster in the pre-intervention arm of the study have met inclusion criteria thus far. Seventy-one percent of patients were male (n=20) and 46% Caucasian (n=13) with median age of 1 year (p25-p75 1-7 years). Eighty-six percent (n=24) had a prior history of epilepsy and patients were taking a median (p25-p75) of 3 (1-4) ASMs prior to the episode. Forty-three percent of episodes (n=12) started at the tertiary pediatric hospital, 1 episode at an ambulatory office, and the remaining episodes (54%, n=15) started at home, school, or other public non-healthcare settings. Fifty-four percent (n=15) of cases were characterized as generalized or focal CSE. Of these, only 1 patient (6.7%, p < 0.001) received medications as directed by the hospital-approved standardized CSE medication algorithm, with ASMs given at inappropriate doses, in a non-standard sequence, or with delay from suggested administration times in all other cases. In patients with CSE (n=15), time to administration of first, second, and third ASMs had a median (p25-p75) time of 11 (7-15), 31 (20-44), and 39 (32-53) minutes, respectively. Additionally, the patients with seizure clusters (n=13) received first, second, and third ASMs at a median (p25-p75) time of 96 (20-200), 182 (106-255), and 171 (158-612) minutes after seizure cluster onset, respectively. Conclusions: Timing from onset of CSE or seizure clusters to administration of ASMs may be delayed and does not follow a standardized protocol in this pilot study. This emphasizes the need for an intervention to improve management of CSE and seizure clusters in an individualized fashion. Funding: Fred Lovejoy Grant, Boston Children's Hospital