Management of convulsive status epilepticus in childhood

Abstract

Convulsive status epilepticus (CSE) is one of the most common pediatric emergencies. The duration of CSE is critical, whereby with increasing duration the cessation of CSE becomes more difficult or less probable and mortality as well as short and long-term complications increase exponentially. Prompt diagnostics and treatment of pediatric CSE (PCSE) are therefore essential. In contrast to adulthood, updated generally accepted guidelines for a structured approach do not yet exist. Based on current evidence the Austrian EpiCARE centers of the Department of Pediatrics at the Medical University Vienna in close cooperation with the Department of Neurology at the Christian Doppler University Hospital in Salzburg developed a continuous documentation process beginning with the time when the young patient was last seen free of symptoms, through prehospital interventions up to admission in the emergency outpatient department and further up to the admission in the pediatric intermediate care (IMC) or intensive care units (PIC). In addition, a pocket card with detailed information on structured specific diagnostics and treatment was developed, which is aimed at guaranteeing rapid adequate measures independent of the staffing by medical personnel (e.g., during night shifts or at weekends). The concept presented here is aimed at sensitizing prehospital and emergency physicians as well as pediatricians at local initial admission centers to further harmonize in-/inter-house treatment standards with the intention of preventing refractory or superrefractory PCSE and possible resulting complications.