Abstracts

Rationale: To analyze pre-hospital and emergency department (ED) treatment of febrile status epilepticus (FSE). Methods: Subjects were children age 1 month to 5 years who are part of a prospective, multicenter study of consequences of FSE which was defined as a febrile seizure or series of seizures lasting >30 minutes. We reviewed the emergency medical service (EMS) and ED management, including seizure recognition, medication administration and respiratory support. Preliminary data (93 of 200 patients) from two sites were analyzed. The remaining cases at the 3 other sites are currently being reviewed.Results: Of the 93 subjects, 83 (89%) received at least one antiepileptic drug (AED). The average time from the first dose of anti-epileptic drug (AED) to end of seizure is 44.8 minutes. The number of AEDs given by EMS and ED per subject ranged from one to six different medications (median=2). Seven patients (8%) were given no AEDs, 19 patients (20%) one AED, 36 patients (39%) two AEDs and 38 patients (41%) received three or more medications. Twenty-five patients were given medication prior to ED, and all were given only one type of medication. The time from last medication given to seizure end ranged from zero to 168 minutes, with a mean of 22 minutes. Abortive therapy was prescribed to 56 patients (60%) on discharge. Rectal diazepam gel was the only abortive medication prescribed to families. Conclusions: Febrile status epilepticus is a neurological emergency requiring prompt recognition and treatment. The multiple medications administered suggest that it rarely stops spontaneously and that early recognition and treatment with sufficient doses of appropriate medication are needed to prevent potential morbidity associated with prolonged febrile seizures. Supported by Grant NS 43209 (PI: S Shinnar MD PhD) from NINDS