What is the management of status epilepticus in pediatric patients?

From the Guidelines

Management of Status Epilepticus in Pediatric Patients

Status epilepticus in pediatric patients is a medical emergency that requires prompt treatment with benzodiazepines, such as lorazepam (0.05-0.1 mg/kg, maximum 1-2 mg, intravenously) 1, administered over 2-5 minutes.

• The initial assessment should include circulation, airway, and breathing (CAB) and provide airway protection interventions, administer high-flow O2, and check blood glucose level 1.
• If seizures persist, second-line treatment with levetiracetam (40 mg/kg, maximum 2,500 mg, intravenously) should be initiated 1.
• Phenobarbital (10-20 mg/kg, maximum 1,000 mg, intravenously) may be added if seizures persist 1.
• Maintenance doses after resolution of status epilepticus include lorazepam (0.05 mg/kg, maximum 1 mg, intravenously every 8 hours for 3 doses), levetiracetam (15-30 mg/kg, intravenously every 12 hours), and phenobarbital (1-3 mg/kg, intravenously every 12 hours) 1.
• Ongoing seizure activity necessitates intensive care unit admission and potential escalation to third-line therapies 1.

From the FDA Drug Label

The safety and effectiveness of lorazepam for status epilepticus have not been established in pediatric patients A randomized, double-blind, superiority-design clinical trial of lorazepam versus intravenous diazepam in 273 pediatric patients ages 3 months to 17 years failed to establish the efficacy of lorazepam for the treatment of status epilepticus. Pediatric patients may exhibit a sensitivity to benzyl alcohol, polyethylene glycol and propylene glycol, components of lorazepam injection

The management of status epilepticus in pediatric patients is not established for lorazepam. Lorazepam is not recommended for pediatric patients due to insufficient data on efficacy and potential sensitivity to its components.

From the Research

Management of Status Epilepticus in Pediatric Patients

The management of status epilepticus in pediatric patients involves several steps and medications.

• First-line treatment typically includes benzodiazepines such as lorazepam, diazepam, or midazolam 2, 3, 4.
• The choice of benzodiazepine may depend on the specific clinical situation and patient characteristics, with lorazepam being less likely to cause respiratory depression than diazepam 2.
• Second-line treatment options include fosphenytoin, levetiracetam, and phenobarbital 2, 5, 6, 4.
• For refractory status epilepticus, treatment options may include continuous infusions of pentobarbital or benzodiazepines, lidocaine, inhalation anesthesia, and propofol 2.
• The treatment of nonconvulsive status epilepticus may involve the use of benzodiazepines, valproate, or other medications, and may require close monitoring and adjustment of treatment as needed 2.
• The management of status epilepticus in pediatric patients should be guided by established treatment algorithms and guidelines, and should take into account the underlying cause of the status epilepticus and the patient's individual needs and circumstances 5, 6, 4.

Treatment Algorithms and Guidelines

• Treatment algorithms for status epilepticus in pediatric patients typically involve a step-wise approach, with first-line, second-line, and third-line treatments 5, 6, 4.
• The American Epilepsy Society (AES) has published guidelines for the treatment of status epilepticus, which provide a framework for the management of this condition in pediatric patients 5.
• Other organizations and institutions may also have their own guidelines and treatment algorithms for status epilepticus in pediatric patients, which should be consulted and followed as appropriate 5, 4.

Medication Dosing and Administration

• The dosing and administration of medications for status epilepticus in pediatric patients should be guided by established guidelines and treatment algorithms 5, 3, 4.
• The choice of medication and dosing regimen may depend on the specific clinical situation and patient characteristics, and should be individualized as needed 3, 4.
• Medications should be administered promptly and effectively, with close monitoring of the patient's response and adjustment of treatment as needed 2, 5, 6, 4.