Abstracts

Rationale: Deviations from status epilepticus (SE) guideline recommendations may occur, including delays in anti-seizure medication (ASM) administration and escalation, and lower than recommended benzodiazepine (BZD) dosing. We aimed to evaluate dosing of the first non-BZD ASM administered in pediatric patients with refractory convulsive SE (RCSE). Methods: Retrospective study of prospectively collected data performed at a tertiary hospital, including patients who were transferred from outside hospitals, from June 2011 to September 2018. We included pediatric patients (1 month – 21 years) with RCSE (ongoing SE after ≥ 2 ASM, including at least 1 non-BZD ASM) who received the first non-BZD ASM at an outside hospital or at our center. We excluded patients with non-convulsive SE at diagnosis, unknown dose of the 1st non-BZD ASM or unknown weight. If a patient had >1 episode of RCSE, we only included the first episode. We describe the type, dosing, and time to administration (from SE onset) of the first non-BZD ASM. Low dose was defined as a dose lower than 25% of the minimum recommended dose [for (fos)phenytoin –FPHT, PHT-, levetiracetam –LEV-, valproate, and phenobarbital –PB-], and high dose, a dose that exceeds the maximum recommended dose by 25%, based on NCS guideline. If a patient was > 50kg, we considered 1000mg as the minimum dose (for all ASM, except for lacosamide –LAC-). Continuous variables are described as median (p25-p75), and categorical variables, as percentage. Results: We studied 85 patients (49% males) with a median age of 4.7 (1.3-10.6) years. Table 1 shows patients’ demographic and clinical characteristics, including history of epilepsy, previous SE, developmental delay, SE etiology, SE type, and site of SE onset. 55% of patients had a history of epilepsy, and 55% presented with SE that started outside the hospital. 36.5% of patients received their first non-BZD ASM in outside hospitals. Table 2 shows ASM choice, ASM dosing, number of low initial doses, time of ASM administration, as well as patients’ characteristics and SE etiology per ASM group. ASM choice was (in order): FPHT (52%), LEV (35%), PB (6%), PHT (5%), and LAC (2%). The first non-BZD ASM was dosed within recommendations in 81% patients (0% high dose, 19% low initial dose [16/85 patients]). Most of the patients who received a low initial dose, received a second dose of the same drug and, therefore, received the minimum recommended dose. Conclusions: FPHT and LEV were the most commonly used drugs as first non-BZD ASM. In most cases, the first non-BZD ASM was dosed within recommendations. No patient received higher than suggested doses and 19% received a low initial dose, which was subsequently complemented by a second dose. Reasons of dividing doses may include medical concerns related to clinical presentation or potential side effects. At times, treatment times exceeded optimal medication application, and analysis of factors related to treatment timing is ongoing to tailor respective interventions. Funding: PERF, ERF, CBA and MAG by FAME.