Abstracts

Generalized convulsive status epilepticus (GCSE) is a medical emergency associated with significant mortality. Seizure duration has been identified as an important contributor to mortality, prompting several publications on treatment algorithms in an effort to decrease the time from onset of GCSE to initiation of treatment. We sought to determine the need for developing guidelines and algorithms by assessing the current management of GCSE within the RQHR. Medical records of patients with a diagnosis of GCSE between April 2001 and March 2002 were reviewed. Demographic data, as well as seizure classification, etiology, treatment (drug, dose, administration, monitoring) and location of treatment initiation were abstracted. Data on 15 patients, 7 males and 8 females, aged 1-88 years (mean, 32 years), who experienced 28 episodes of GCSE were available for analysis. Low antiepileptic drug concentration was determined to be the seizure etiology in 54% of the episodes, while GCSE occurred secondary to alcohol withdrawal, infections, trauma and hypoxia in 18% of the episodes. Etiology was indeterminate for 8 episodes. Treatment was initiated outside of a hospital in 17 episodes (61%), in the emergency room (ER) in 25% and in the hospital in 15% of the episodes. Diazepam (DZP) was the initial drug used in 24 episodes, lorazepam (LZP) in 3 episodes and midazolam (MDZ) in 1 episode. A second agent was required in 21 episodes, with phenytoin (PHT) being used in 10 episodes, DZP in 4, LZP in 3 and both MDZ and phenobarbital being used in 2 episodes each. A third agent was required in 13 episodes, with PHT being used in 8, MDZ in 4 and LZP used in one episode. Of those episodes of GCSE in pediatric patients where DZP was administered initially, doses ranged from 1-15 mg administered intravenously (i.v.), and repeated 2-4 times over a period of 28-70 minutes. In adults DZP doses of 5[ndash]30 mg i.v. were administered. LZP was used as initial therapy in 3 episodes, 2 of which were in a 10 year old child. Both times, parents initiated treatment at home with LZP 1 mg x 3 doses, and emergency medical services arrived to administer DZP. In the third episode, an adult received an initial dose of LZP 2mg (0.018 mg/kg) in the ambulance followed by 4 x 1 mg doses administered in the ER over 240 minutes (for a total dose of 0.05 mg/kg). PHT was used in 18 episodes of GCSE. A dose of [ge]15 mg/kg was used in 33% of the episodes (range: 8[ndash]20 mg/kg). PHT was infused at a rate of 50 mg/min in 22% of the episodes, at rates of 20[ndash]50 mg/min in another 22% and at [lt]20 mg/min in 33% of the episodes (range: 3[ndash]50 mg/min). Standardization of the treatment of GCSE through guidelines and an algorithm is necessary to decrease the discrepancies in dosing, infusion rates and the response time to treatment.