Abstract Details

Title Clinical Characteristics and Treatment Strategies in Refractory Convulsive Status Epilepticus in Children: Results from the Pediatric Status Epilepticus Research Group (pSERG)

Topic Child Neurology/Developmental Neurobiology

Presentation(s) P03 - (-)

Poster/Presentation
Number 012

Objective

Background BACKGROUND: There is insufficient literature on the different treatment regimens for pediatric RCSE.

Design/Methods DESIGN/METHODS: We performed a prospective multicenter study and enrolled children with RCSE from 7 different reference hospitals in the United States from June 2011 to September 2012, inclusive. We included all patients with: 1) Status epilepticus (SE) with a convulsive onset, 2) age 30 days to 21 years, and 3) Refractory to, at least, 2 different antiepileptic drugs (AEDs) (benzodiazepines not administered as a continuous infusion was one medication), or required at least one continuous infusion of AEDs.

Results RESULTS: Forty patients (23 males) ranging in age from 0.2 to 17.7 (median: 2.6) years met our inclusion criteria. At onset, the CSE was continuous (35%) or intermittent seizures without return to baseline (60%). Baseline medical conditions were developmental delay (42.5%), epilepsy (37.5%), prior episode of SE (20%) and cerebral palsy (7.5%). The etiology of SE was structural (22.5%), metabolic (12.5%), genetic (7.5%) and unknown (57.5%). The median (interquartile range) time in minutes from seizure onset to: 1) first AEDs was 17.5 (5-65.3) 2) first non-benzodiazepine was 60 (30-112.5), 3) second non-benzodiazepine was 96 (75.5-322.5), and 4) end of the convulsive status epilepticus was 120 (71.3-207). The AEDs were: 1) first: lorazepam (40.4%), diazepam (19.2%), midazolam (11.5%); 2) first non-benzodiazepine: fosphenytoin (38.5%), phenytoin (17.3%), levetiracetam (5.8%), phenobarbital (3.8%), valproate (1.9%); 3) second non-benzodiazepine: phenobarbital (34.6%), fosphenytoin (9.6%), levetiracetam (9.6%), phenytoin (3.8%), valproate (3.8%). Continuous infusions were used in 14 patients: midazolam (12), pentobarbital (1), and propofol (1). Three patients required a second infusion with midazolam (2) and pentobarbital (1).

Conclusions CONCLUSIONS: In our series, RCSE was more frequently intermittent, and of undetermined etiology. Although AEDs used followed published guidelines, the period between administration of benzodiazepines and non-benzodiazepines was prolonged.

Authors/Disclosures
PRESENTER	No disclosure on file
Nicholas S. Abend, MD, FAAN (Children's Hospital of Philadelphia)	Dr. Abend has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Epilepsy Foundation. The institution of Dr. Abend has received research support from NIH. The institution of Dr. Abend has received research support from PCORI. Dr. Abend has received publishing royalties from a publication relating to health care.
Thomas Leist, MD, PhD, FAAN (Thomas Jefferson University)	Dr. Leist has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Leist has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Leist has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Leist has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Horizon. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Seono. Dr. Leist has received personal compensation in the range of $10,000-$49,999 for serving as a Expert Wittness with DHHS HRSA.
Satish Agadi, MD (IONVA HEALTHCARE)	Dr. Agadi has nothing to disclose.
	No disclosure on file
Ravindra Arya	The institution of Ravindra Arya has received research support from National Institutes of Health. The institution of Ravindra Arya has received research support from Cincinnati Children's Research Foundation.
Jessica Carpenter, MD (PNCC Diagnostics)	Dr. Carpenter has nothing to disclose.
Kevin E. Chapman, MD (Barrow Neurological Institute at Phoenix Children's Hospital)	No disclosure on file
William D. Gaillard, MD (Children'S National Hospital)	The institution of Dr. Gaillard has received research support from all federal or foundation grants, NINDS, NIDCD, NICHD, NSF ,PERF.
Tracy A. Glauser, MD (Childrens Hosp Med Ctr Dept of Neuro)	Dr. Glauser has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Neurelis. Dr. Glauser has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for WebMD. The institution of Dr. Glauser has received research support from NIH. Dr. Glauser has received intellectual property interests from a discovery or technology relating to health care. Dr. Glauser has received publishing royalties from a publication relating to health care.
Howard P. Goodkin, MD, PhD, FAAN (University of Virginia)	Dr. Goodkin has received research support from NIH. Dr. Goodkin has received publishing royalties from a publication relating to health care.
Mohamad A. Mikati, MD (Duke University Medical Center)	No disclosure on file
Katrina Peariso, MD, PhD	No disclosure on file
Sriram Ramgopal	No disclosure on file
Margie A. Ream, MD, PhD, FAAN (Nationwide Children'S Hospital/The Ohio State University)	Dr. Ream has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bluebird Bio. Dr. Ream has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for United Council for Neurologic Subspecialties. Dr. Ream has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Rushton, Stakely, Johnston & Garrett, P.A. . Dr. Ream has received personal compensation in the range of $10,000-$49,999 for serving as a Evidence Review Group member with Health Resources and Services Administration. Dr. Ream has received personal compensation in the range of $0-$499 for serving as a Organizational representative with Child Neurology Society.
Tobias Loddenkemper, MD, FAAN	No disclosure on file

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