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VOLUME 28 , ISSUE 5 ( May, 2024 ) > List of Articles


Survey of Pediatric Status Epilepticus Treatment Practices and Adherence to Management Guidelines (Pedi-SPECTRUM e-Survey)

Renu Suthar, Suresh Kumar Angurana, Karthi Nallasamy, Arun Bansal, Jayashree Muralidharan

Keywords : Antiseizure medications, Midazolam, Nonconvulsive status epilepticus, Status epilepticus, Thiopentone

Citation Information : Suthar R, Angurana SK, Nallasamy K, Bansal A, Muralidharan J. Survey of Pediatric Status Epilepticus Treatment Practices and Adherence to Management Guidelines (Pedi-SPECTRUM e-Survey). Indian J Crit Care Med 2024; 28 (5):504-510.

DOI: 10.5005/jp-journals-10071-24707

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim: Survey of treatment practices and adherence to pediatric status epilepticus (PSE) management guidelines in India. Methods: This eSurvey was conducted over 35 days (15th October to 20th November 2023) and included questions related to hospital setting; antiseizure medications (ASMs); ancillary treatment; facilities available; etiology; and adherence to PSE management guidelines. Results: A total of 170 respondents participated, majority of them were working in tertiary level hospitals (94.1%) as pediatric intensivists (56.5%) and pediatricians (19.4%), and were in clinical practice for 2–10 years (46.5%). Majority use intravenous (IV) midazolam and levetiracetam as first- and second-line ASMs (67.1 and 51.2%, respectively). In cases with refractory status epilepticus (RSE), the most commonly used ASM is midazolam infusion (92.4%). For super-refractory status epilepticus (SRSE), the commonly used third-line ASMs include midazolam infusion (34.1%), thiopentone infusion (26.5%), high dose phenobarbitone (18.2%), and ketamine infusion (15.3%). Overall, in cases with SRSE, 44.7% respondents use ketamine infusion, 42.5% use add-on oral topiramate, and 34.7% use high-dose phenobarbitone (1–3 mg/kg/hour) infusion. Most respondents targeted both clinical and EEG seizure control (48.8%). Ancillary treatment used for SRSE included IV pyridoxine (57.1%), methylprednisolone (45.3%), IVIG (42.4%), ketogenic diet (40.6%), and second-line immunomodulation (33.5%). Most common causes were febrile SE, viral encephalitis, and febrile illness-related epilepsy syndrome (60.6%, 52.4%, and 37.1%, respectively). Facilities available included pediatric intensive care units (PICU) (97.1%), mechanical ventilation (98.2%), pediatric neurologist (68.8%), MRI brain (86.5%), EEG (69.4%), and viral PCR (58.2%). The compliance with guidelines for timing of initiation of ASM ranged from 63.5 to 88.8%. Conclusion: Intravenous midazolam bolus/es, levetiracetam, and midazolam infusion are commonly used first-, second-, and third-line ASMs, respectively. There were wide variations in use of ASMs for RSE and SRSE, ancillary treatment, and compliance to PSE management guidelines.

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  1. Chin RFM. The outcomes of childhood convulsive status epilepticus. Epilepsy Behav 2019;101(Pt B):106286. DOI: 10.1016/j.yebeh.2019.04.039.
  2. Kling R, Ritvanen J, Mustonen H, Kämppi L. Long-term outcome of convulsive status epilepticus: A 10-year follow-up. Epileptic Disord 2022;24(6):1046–1059. English. DOI: 10.1684/epd.2022.1482.
  3. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-based guideline: Treatment of convulsive status epilepticus in children and adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016;16(1):48–61. DOI: 10.5698/1535-7597-16.1.48.
  4. Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, et al. European Resuscitation Council Guidelines 2021: Paediatric life support. Resuscitation 2021;161:327–387. DOI: 10.1016/j.resuscitation.2021.02.015.
  5. Mishra D, Sharma S, Sankhyan N, Konanki R, Kamate M, Kanhere S, et al. Multi-disciplinary group on management of status epilepticus in children in India. Consensus guidelines on management of childhood convulsive status epilepticus. Indian Pediatr 2014;51(12):975–990. DOI: 10.1007/s13312-014-0543-4.
  6. Singhi S, Angurana SK. Principles of management of central nervous system infections. Indian J Pediatr 2019;86(1):52–59. DOI: 10.1007/s12098-017-2583-y.
  7. Lyttle MD, Rainford NEA, Gamble C, Messahel S, Humphreys A, Hickey H, et al. Paediatric emergency research in the United Kingdom & Ireland (PERUKI) collaborative. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): A multicentre, open-label, randomised trial. Lancet 2019;393(10186):2125–2134. DOI: 10.1016/S0140-6736(19) 30724-X.
  8. Dalziel SR, Borland ML, Furyk J, Bonisch M, Neutze J, Donath S, et al. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): An open-label, multicentre, randomised controlled trial. Lancet 2019;393(10186):2135–2145. DOI: 10.1016/S0140-6736(19)30722-6.
  9. Angurana SK, Suthar R. Efficacy and safety of levetiracetam vs. phenytoin as second line antiseizure medication for pediatric convulsive status epilepticus: A systematic review and meta-analysis of randomized controlled trials. J Trop Pediatr 2021;67(2):fmab014. DOI: 10.1093/tropej/fmab014.
  10. McTague A, Martland T, Appleton R. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev 2018;1(1):CD001905. DOI: 10.1002/14651858.CD001905.pub3.
  11. Patten W, Naqvi SZ, Raszynski A, Totapally BR. Complications during the management of pediatric refractory status epilepticus with benzodiazepine and pentobarbital infusions. Indian J Crit Care Med 2015;19(5):275–277. DOI: 10.4103/0972-5229.156476.
  12. Masapu D, Gopala Krishna KN, Sanjib S, Chakrabarti D, Mundlamuri RC, Manohar N, et al. A comparative study of midazolam and target-controlled propofol infusion in the treatment of refractory status epilepticus. Indian J Crit Care Med 2018;22(6):441–448. DOI: 10.4103/ijccm.IJCCM_327_17.
  13. Nuñez P, Hansen J, Aprea V, Álvarez Ricciardi MB, Oviedo S, Fustiñana A, et al. Management of status epilepticus in childhood: A survey conducted at pediatric hospitals in the City of Buenos Aires. Arch Argent Pediatr 2023;121(2):e202202696. DOI: 10.5546/aap.2022-02696.eng.
  14. Dedeoglu Ö, Akça H, Emeksiz S, Kartal A, Kurt NÇ. Management of status epilepticus by different pediatric Departments: Neurology, intensive care, and emergency medicine. Eur Neurol 2023;86(5): 315–324. DOI: 10.1159/000533191.
  15. Kowoll CM, Klein M, Salih F, Fink GR, Stetefeld HR, Onur OA, et al. IGNITE status epilepticus survey: A nationwide interrogation about the current management of status epilepticus in Germany. J Clin Med 2022;11(5):1171. DOI: 10.3390/jcm11051171.
  16. Philpott NG, Dante SA, Philpott D, Perin J, Bhatia P, Henderson E, et al. Treatment guideline nonadherence pretransport associated with need for higher level of care in children transferred to a pediatric tertiary care center for status epilepticus. Pediatr Emerg Care 2023;39(10):780–785. DOI: 10.1097/PEC.0000000000002952.
  17. Tyson M, Trenear R, Skellett S, Maconochie I, Mullen N. Survey about second-line agents for pediatric convulsive status epilepticus. Pediatr Emerg Care 2023;39(4):247–252. DOI: 10.1097/PEC.0000000000002745.
  18. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus – Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015;56(10):1515–1523. DOI: 10.1111/epi.13121.
  19. Pujar SS, Martinos MM, Cortina-Borja M, Chong WKK, De Haan M, Gillberg C, et al. Long-term prognosis after childhood convulsive status epilepticus: A prospective cohort study. Lancet Child Adolesc Health 2018;2(2):103–111. DOI: 10.1016/S2352-4642(17)30174-8.
  20. Vasquez A, Farias-Moeller R, Tatum W. Pediatric refractory and super-refractory status epilepticus. Seizure 2019;68:62–71. DOI: 10.1016/j.seizure.2018.05.012.
  21. Crawshaw AA, Cock HR. Medical management of status epilepticus: Emergency room to intensive care unit. Seizure 2020;75:145–152. DOI: 10.1016/j.seizure.2019.10.006.
  22. Payne ET, Zhao XY, Frndova H, McBain K, Sharma R, Hutchison JS, et al. Seizure burden is independently associated with short term outcome in critically ill children. Brain 2014;137(Pt 5):1429–1438. DOI: 10.1093/brain/awu042.
  23. Fung FW, Carpenter JL, Chapman KE, Gallentine W, Giza CC, Goldstein JL, et al. Survey of pediatric ICU EEG monitoring-reassessment after a decade. J Clin Neurophysiol 2023;10:1097/WNP.0000000000001006. DOI: 10.1097/WNP.0000000000001006.
  24. van Baalen A. Febrile infection-related epilepsy syndrome in childhood: A clinical review and practical approach. Seizure 2023;111:215–222. DOI: 10.1016/j.seizure.2023.09.008.
  25. Barcia Aguilar C, Sánchez Fernández I, Loddenkemper T. Status epilepticus-work-up and management in children. Semin Neurol 2020;40(6):661–674. DOI: 10.1055/s-0040-1719076.
  26. Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain 2012;135(Pt 8):2314–2328. DOI: 10.1093/brain/aws091.
  27. AlMohaimeed BA, Hundallah KJ, Bashiri FA, AlMohaimeed SA, Tabarki BM. Evaluation of adherence to pediatric status epilepticus management guidelines in Saudi Arabia. Neurosciences (Riyadh) 2020;25(3):182–187. DOI: 10.17712/nsj.2020.3.20190106.
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