MANAGEMENT OF REFRACTORY STATUS EPILEPTICUS IN CHILDREN
Abstract number :
1.164
Submission category :
Year :
2003
Submission ID :
3819
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Syed A. Hosain, Novette S. Green Pediatric Epilepsy Center, New York Presbyterian/Weill Cornell Medical College, New York, NY
There are only a handful of studies that report on the efficacy of the treatment of Refractory Status Epilepticus (RSE). In this report we present our experience on the efficacy of barbiturates and benzodiazapine coma in the treatment of RSE.
In a retrospective chart review of patients admitted to the Pediatric Intensive Care Unit (PICU) from 1997-2002, we identified 17 patients with Status Epilepticus. Seven of these patients had refractory Status Epilepticus (RSE) Patients with RSE were treated with continuous midazolam and/ or pentobarbital infusion. Continuous Electroencephalography (EEG) monitoring with 16 Channel EEG was used to guide management. We collected information on demographics, pharmacological treatment and EEG. Efficacy of treatment was the primary outcome measure. EEG changes during treatment and treatment emergent side-effects were secondary measures.
Mean age of the population was 4.5 years (range 1.5 weeks - 5 years). The mean dose of midazolam was 0.5mg/kg/hr (range 0.2mg.kg.hr [ndash] 1.4mg/kg/hr). The mean dose of pentobarbital was 3mg/kg/hr (range 0.9 [ndash] 5mg/kg/hr).
Five patients initially treated with midazolam were then treated with pentobarbital. One patient received midazolam only. One patient received pentobarbital only.
Treatment Outcome:
1. Five out of six patients treated with midazolam did not respond.
2. All five non-responders to midazolam responded to pentobarbital.
3. All six patients who received pentobarbital responded.
4. Only one patient receiving midazolam responded.
EEG findings:
1. No patient receiving midazolam (n=6) achieved suppression burst pattern (S-B).
2. Six of seven patients receiving pentobarbital showed S-B pattern.
Adverse Effects:
1. Three patients on Pentobarbital developed hemodynamic cardiovascular instability.
2. Only one patient on midazolam developed cardiovascular instability.
In this small cohort of patients Pentobarbital appeared more potent for treatment of RSE. EEG changes are more predictive with use of pentobarbital. Midazolam is less likely to cause hemodynamic instability when compared to pentobarbital. More studies are needed to determine the most effective and safe treatment modality for RSE.