Time from convulsive status epilepticus onset to anticonvulsant administration in children

Iván Sánchez Fernández; Nicholas S Abend; Satish Agadi; Sookee An; Ravindra Arya; James Nicholas Brenton; Jessica L Carpenter; Kevin E Chapman; William D Gaillard; Tracy A Glauser; Howard P Goodkin; Kush Kapur; Mohamad A Mikati; Katrina Peariso; Margie Ream; James Riviello Jr; Robert C Tasker; Tobias Loddenkemper; Pediatric Status Epilepticus Research Group (pSERG)

doi:10.1212/WNL.0000000000001673

Time from convulsive status epilepticus onset to anticonvulsant administration in children

Neurology. 2015 Jun 9;84(23):2304-11. doi: 10.1212/WNL.0000000000001673. Epub 2015 May 6.

Authors

Iván Sánchez Fernández¹, Nicholas S Abend¹, Satish Agadi¹, Sookee An¹, Ravindra Arya¹, James Nicholas Brenton¹, Jessica L Carpenter¹, Kevin E Chapman¹, William D Gaillard¹, Tracy A Glauser¹, Howard P Goodkin¹, Kush Kapur¹, Mohamad A Mikati¹, Katrina Peariso¹, Margie Ream¹, James Riviello Jr¹, Robert C Tasker¹, Tobias Loddenkemper²; Pediatric Status Epilepticus Research Group (pSERG)

Affiliations

¹ From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY.
² From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (I.S.F., S. An, K.K., T.L.), and the Division of Critical Care, Departments of Neurology, Anesthesiology, Perioperative and Pain Medicine (R.C.T.), Boston Children's Hospital, Harvard Medical School, MA; the Department of Child Neurology (I.S.F.), Hospital Sant Joan de Déu, University of Barcelona, Spain; the Division of Neurology (N.S.A.), The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania; the Section of Neurology and Developmental Neuroscience, Department of Pediatrics (S. Agadi), Baylor College of Medicine, Houston, TX; the Comprehensive Epilepsy Center (R.A., T.A.G.), Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH; the Departments of Neurology and Pediatrics (J.N.B., H.P.G.), The University of Virginia Health System, Charlottesville; the Department of Epilepsy, Neurophysiology, and Critical Care Neurology (J.L.C., W.D.G.), Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC; the Departments of Pediatrics and Neurology (K.E.C.), Children's Hospital Colorado, University of Colorado School of Medicine, Aurora; the Division of Pediatric Neurology (M.A.M.), Duke University Medical Center, Duke University, Durham, NC; the Division of Neurocritical Care (K.P.), University of Cincinnati Medical Center, OH; the Division of Pediatric Neurology (M.R.), Nationwide Children's Hospital, The Ohio State University, Columbus; and the Division of Child Neurology (J.R.), Columbia University Medical Center, Columbia University, New York, NY. tobias.loddenkemper@childrens.harvard.edu.

Abstract

Objective: To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED).

Methods: This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE.

Results: We enrolled 81 patients (44 male) with a median age of 3.6 years. The first, second, and third AED doses were administered at a median (p25-p75) time of 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes after SE onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2-3) doses of benzodiazepines were administered before switching to nonbenzodiazepine AEDs. The first and second doses of nonbenzodiazepine AEDs were administered at 69 (40-120) minutes and 120 (75-296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5-15) minutes and 16 (10-40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset).

Conclusions: The time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the prehospital and in-hospital settings.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Anticonvulsants / administration & dosage*
Benzodiazepines / administration & dosage*
Child
Child, Preschool
Clinical Protocols*
Female
Hospitalization / statistics & numerical data
Humans
Infant
Male
Prospective Studies
Status Epilepticus / drug therapy*
Time Factors
Treatment Outcome

Substances

Anticonvulsants
Benzodiazepines

Grants and funding

T32 NS047996/NS/NINDS NIH HHS/United States