Childhood convulsive status epilepticus: epidemiology, management and outcome |
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Authors: | B. G. R. Neville R. F. M. Chin R. C. Scott |
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Affiliation: | Neurosciences Unit, University College, Institute of Child Health, and Great Ormond Street Hospital for Children, NHS Trust, London, UK |
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Abstract: | Convulsive status epilepticus (CSE) in childhood is a medical emergency and its aetiology and outcome mean that it should be studied separately from adult CSE. The incidence in developed countries is between 17 and 23/100,000 with a higher incidence in younger children. Febrile CSE is the commonest single group with a good prognosis in sharp distinction to CSE related to central nervous system infections which have a high mortality. The aim of treatment is to intervene at 5 min and studies indicate that intravenous (i.v.) lorazepam may be a better first-line treatment than rectal diazepam and i.v. phenytoin a better second-line treatment than rectal paraldehyde. An epidemiological study strongly supports the development of prehospital treatment with buccal midazolam becoming a widely used but unlicensed option in the community. More than two doses of benzodiazepines increase the rate of respiratory depression without obvious benefit. The 1 year recurrence rate is 17% and the hospital mortality is about 3%. |
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Keywords: | convulsive status epilepticus childhood epidemiology management |
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