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Journal of Child Neurology
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0883073809332768v1
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Management of Prolonged Seizures and Status Epilepticus in Childhood: A Systematic Review

Kalliopi Sofou, MD

Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden, kalliopi.sofou{at}vgregion.se

Ragnhildur Kristjánsdóttir, MD, PhD

Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden

Nikolaos E. Papachatzakis, MD

Department of Rehabilitation, Sahlgrenska University Hospital, Göteborg, Sweden

Amir Ahmadzadeh, MD

Child Rehabilitation Göteborg, Sweden

Paul Uvebrant, MD, PhD

Department of Pediatrics, Sahlgrenska University Hospital, Göteborg, Sweden

Pediatric prolonged seizures and status epilepticus are medical emergencies necessitating immediate life-support and seizure-control measures. A systematic review of published data on the management of prolonged seizures and status epilepticus showed that buccal midazolam was significantly more effective than rectal diazepam, reaching a seizure-control rate of 70% and recurrence rate of 8%. Intranasal lorazepam was as effective as intramuscular paraldehyde in a cost-restrained setting. In refractory status epilepticus, both intravenous midazolam and valproate were equally effective to intravenous diazepam, with valproate exhibiting significantly faster seizure cessation and safer profile than diazepam, even in infancy. In conclusion, buccal midazolam is efficacious and safe thanks to its convenient route of administration, which may serve as first-line in the treatment of prolonged seizures. Intranasal lorazepam is an effective, easy-to-use, and safe drug for prolonged seizures. Intravenous valproate exhibits favorable efficacy and safety profile as third-line in status epilepticus, refractory to diazepam and phenytoin.

Key Words: status epilepticus • prolonged seizures • treatment • midazolam • lorazepam • valproate • systematic review • refractory • buccal • intranasal

This version was published on August 1, 2009

Journal of Child Neurology, Vol. 24, No. 8, 918-926 (2009)
DOI: 10.1177/0883073809332768
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