German-wide survey on the management of status epilepticus in children

Zielsetzung: Status epilepticus (SE) is infrequent, so it is a challenge regarding quick and appropriate diagnosis and therapy. Nevertheless, there are few studies about the optimal handling of SE especially in children.

Methodik: Germany-wide questionnaire on the current management of SE in pediatric clinics (n = 368).

Ergebnis: Until December 2012, 29 questionnaires were sent back (7, 8%). About 48% traditionally define the SE by its duration of at least 30 minutes. Approximately 21% specify a minimum duration of 5 minutes. This is corresponding to the current recommendations of a developing SE. About 86% are able to provide a standard of care for SE. In persistence of seizures 33% benzodiazepines give more than twice, although more than twice applications are not effective and more often cause a respiratory depression instead. Parenteral lorazepam (51%) or diazepam (48%) rank first. Second choice is phenobarbital (37%).

Mostly (66%) the same or the next drug is given after more than 5 minutes again. In ICU midazolam is the medication of choice (82%). First alternative is thiopental (46%). Primary therapeutic effect is stop of the clinical seizures (82%), in 31% stop of electrographic seizures and in 17% a burst-suppression pattern. About 65% treat a focal or absence differently from a tonic-clonic SE. An attempt of additional enteral therapy is made in 44%, immune therapy is tried in 48%. Half of the pediatric clinics provide ketogenic diet. In 86% of ICU the SE is treated together with neuropediatricians.

MRI is available everywhere, a cEEG in 50% and aEEG in 65%. Neuronal antibodies as a possible cause are known in 58%.

Among of nonenteral acute drugs diazepam rectal tube ranks first (86%). Second choice is Tavor expedite (41%) although it is not licensed and works too slowly.

Schlussfolgerung: The responding rate of the questionnaires is low. The management of SE in regard to definition, diagnosis, and therapy seems to be diverse at the responding pediatric clinics. Therefore, multicenter treatment-studies and consistent standards of therapy seem important for an efficient treatment of SE in children.