Timing and selection of first antiseizure medication in patients with pediatric status epilepticus

Abstract

Objective: Pediatric status epilepticus (SE) may be associated with significant morbidity. We sought to evaluate timing and selection of antiseizure medications (ASM) in patients presenting in SE to a pediatric emergency department (ED). We hypothesized that delays in initial treatment are associated with longer overall duration of SE.

Methods: We identified patients with SE presenting to a single urban, academic pediatric hospital ED from 2009-2015. Patients were included in the study population with physician-documented ICD-9 code of SE. Medical record reviews were used to verify timing of seizure onset, ASM dosing, route, and timing.

Results: 141 patients had complete documentation to determine medication dosing and timing related to seizure onset. There were 75 boys and 66 girls. Median age was 45 months (IQR 20-97.5 months). Median overall duration of SE was 61.5 min (IQR 36-120 min). Median time to first ASM dose (whether given by parent, EMT or in ED) was 25 min (IQR 7-56 min). First dose ASM was a benzodiazepine (BDZ) in 92% of patients (130/141) and second-dose ASM was a BDZ in 95% of patients (90/95). Median seizure duration was 59.5 min and 151.5 min in patients who received first dose ASM in under 5 min and 60 min or more after seizure onset, respectively (p < 0.01). SE was stopped by first dose ASM in 32% of patients.

Significance: Our data suggest that there are delays in first dose ASM in patients presenting to our ED with SE. These results support the view that delays in initial ASM administration are associated with prolonged SE in some patients. A group of patients with prolonged SE had complete resolution after single dose of benzodiazepine, indicating that not all prolonged seizures become refractory.

Keywords: All epilepsy/seizures; All pediatric; Patient safety; Status epilepticus.