Status Epilepticus: Shifts in Thinking on Treatment

Epileptic seizures that last for 30 minutes or more (status epilepticus) are life-threatening. In research presented at the American Epilepsy Society 69^th Annual Meeting in Philadelphia, PA, experts offered new findings on promising treatments and information on which ones are not recommended.

Keven Chapman, MD, of Children’s Hospital Colorado in Denver, CO, and colleagues reported that children in status epilepticus should not be given continuous IV infusions if they fail to respond to two antiepileptic drugs.

The team studies the cases of 111 children treated at nine US tertiary pediatric hospitals who had seizures that did not stop even after they got two drugs. They ranged in age from one to 10 years old. About half (55 patients) got continuous infusion therapy.

These children needed more intensive care stays, and needed them for longer duration than children who did not get the infusions. Their seizures did not resolve more quickly, in fact they continued longer, the researchers said. “Given this variation in response and morbidity, continuous infusion therapy may not be appropriate for all refractory status epilepticus patients,” they concluded.

The sedative ketamine is getting more popular for treating some of these children, researchers from New York Presbyterian Hospital/Weill Cornell reported.

Lead author Sotirios Keros, MD, PhD, of Weill Cornell, said in an abstract presented at the meeting that numbers are up both in terms of hospitals using the drug and the numbers of children treated with ketamine. But these children required longer stays in the ICU, longer EEG monitoring, more frequent use of blood pressure medications, and spent more time on ventilators, they noted.

The team reviewed cases recorded in the Pediatric Hospital Information System national database.

Researchers from Detroit earlier reported on their own results with ketamine.

Boston researchers presented the results of a multi-center analysis of status epilepticus in children focusing on how long the condition lasts.

They reviewed the cases of 190 children treated for the disorder, many of whom had co-morbidities including developmental delay, cerebral palsy, and febrile seizures.

The team’s main finding was that duration of the seizures depended mostly on what was causing them—whether the epilepsy was structural, genetic, metabolic, or caused by unknown factors. The time to treatment was also a key factor in seizure duration, said Michele Jackson, a research assistant at Boston Children’s Hospital who was one of the abstract’s authors.