Abstracts

Rationale: Early and effective treatment of status epilepticus (SE) in children is important to reduce the risk of mortality and the development of subsequent neurological and cognitive deficits. Survey among experts in pediatric epilepsy management has been performed to illustrate clinical practice and provide recommendations on SE management in Poland. Methods: A questionnaire survey has been performed among pediatric epileptologists. They were asked to evaluate the usefulness of therapeutic options in described clinical situations of convulsive SE, absence SE and complex partial SE. Questions concerned both initial and subsequent treatments in case of continued seizures. Experts rated utility of treatment options using a 9-point scale. The mean, standard deviation, and 95% confidence interval as well chi-square testing were performed to categorize treatment options as treatment of choice and from 1st to 3rd line treatments. Results: The survey was sent to 70 experts, of whom 51 (73%) completed the questionnaire. As initial therapy for all types of pediatric SE, i.v. diazepam was treatment of choice. For generalized tonic-clonic SE, rectal diazepam was treatment of choice and i.v. valproate (VPA) was another first-line option. When there was no seizures cessation after i.v. diazepam use, experts suggested using as a treatment of choice either i.v. VPA injection or i.v. phenytoin (PHT) or i.v. phenobarbital as an alternative. In case of absence SE i.v. VPA was the treatment of choice. For complex partial SE other first-line treatments were rectal diazepam and IV PHT. In case of lack of efficacy of i.v. diazepam subsequent first line treatments were i.v. VPA and i.v. PHT. Often highly rated were second-line options as i.v. lorazepam, i.v. midazolam and fosphenytoin (not available in Poland). Conclusions: The expert recommendations reflect clinical utility and the local availability of treatment options. The results are generally consistent with recommendations of other experts panels. It should be noted, that despite the fact that the needs for treatment of pediatric SE are covered in Poland, some second-line treatment options which are useful in managing this life-threating condition are not available. UCB Pharma, Warsaw, Poland supported preparation and distribution of questionnaires, data management and analysis, preparation of figures and preparation of this poster.