scholarly journals Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Jo Marie. B. Sourbron ◽  
Lieven Lagae ◽  
Dalila Ibrahimo Sulemane
Keyword(s):  
Status Epilepticus ◽  
Developed Countries ◽  
Convulsive Status Epilepticus ◽  
Second Line ◽  
Limited Data ◽  
Optimal Care ◽  
Resource Limited ◽  
Prehospital Management ◽  
Significant Difference ◽  
Line Drug

Background: Optimal care of Convulsive status epilepticus (CSE) can be related to multiple barriers in resource-limited countries. Objectives and methods: Since limited data of CSE management are available from South-East Africa, we performed a retrospective analysis of the electronic records of pediatric patients with CSE admitted to the Maputo Central hospital from January 2016 until April 2019. Results: Our database consisted out of 39 patients. The average age was 5.15 (range 0.3-13.8) years and demographic characteristics did not show a relation to CSE characteristics or outcomes. However, the total stay in the hospital was negatively correlated with age (p=0.0314). Moreover, 14 patients needed to be admitted to the IC, which was correlated to having generalized motor seizures (p=0.0253), and a relatively higher need for a second AED to control their CSE (p=0.0131). Regarding AED use, the first AED was a IV benzodiazepine (BZD: midazolam (MIDA) or diazepam (DIAZ)) or IV phenytoin (PHEN) when BZDs were not available. There was no statistically significant difference between the efficacy of MIDA vs. DIAZ. Eleven patients received PHEN as a second-line drug, of which only two patients needed an additional dose of PHEN. None of the patients died and five patients (13.2%) had an extra comorbidity after CSE. Conclusions: Although limited AEDs were available in our study, compared to more AEDs in other developing and developed countries, we report the successful cessation of CSE in the majority of cases. We recommend strategies to improve prehospital management such as the use of non-IV BZD use, to limit the need for patients to be admitted to the IC and thereby potentially decreasing the number of AEDs, morbidity and hospital duration. Moreover, our data underline the conversion to second-line AEDs (PHEN) to be adequate in nearly all patients.

Intravenous brivaracetam for the management of refractory focal non-convulsive status epilepticus

2020 ◽  
Vol 13 (11) ◽  
pp. e234955
Author(s):  
Abdalla A Ammar ◽  
Mahmoud A Ammar ◽  
Kent Owusu ◽  
Emily J Gilmore
Keyword(s):  
Status Epilepticus ◽  
Synaptic Vesicle ◽  
Convulsive Status Epilepticus ◽  
Limited Data ◽  
Patient Case ◽  
Diagnosis And Management ◽  
Continuous Electroencephalography

Diagnosis and management of status epilepticus (SE), including non-convulsive status epilepticus (NCSE), is challenging, with a reported 30%–50% of epilepticus patients not responding to available antiseizure medications (ASMs). Injectable benzodiazepines, fosphenytoin, valproate, levetiracetam, lacosamide and phenobarbital are commonly used for treating SE. Brivaracetam, a new ASM, with higher affinity and greater selectivity for the synaptic vesicle glycoprotein 2A than levetiracetam, has been approved as monotherapy or adjunct for treatment of focal onset seizures. Brivaracetam may have a role in the management of SE. However, limited data exist on brivaracetam’s efficacy in SE. We describe a patient case with focal NCSE refractory to levetiracetam, fosphenytoin, lacosamide and valproate who demonstrated clinical and electrographic improvement on continuous electroencephalography monitoring after brivaracetam administration.

scholarly journals Institutional Pediatric Convulsive Status Epilepticus Protocol Decreases Time to First and Second Line Anti-Seizure Medication Administration

Seizure ◽  
2020 ◽  
Vol 81 ◽  
pp. 263-268 ◽  
Author(s):  
Steven P. Trau ◽  
Emily C. Sterrett ◽  
Lydia Feinstein ◽  
Linh Tran ◽  
William B. Gallentine ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Medication Administration ◽  
Convulsive Status Epilepticus ◽  
Second Line

Efficacy of Home Anticonvulsant Administration for Second-Line Status Epilepticus Treatment

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012414
Author(s):  
Rafael Wabl ◽  
Samuel W Terman ◽  
Maria Kwok ◽  
Jordan Elm ◽  
James Chamberlain ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Adverse Events ◽  
Primary Outcome ◽  
Study Drug ◽  
Convulsive Status Epilepticus ◽  
Data Allocation ◽  
Second Line ◽  
Medication Regimen ◽  
Home Medication ◽  
Anticonvulsant Medication

Objective:To investigate whether receiving a second-line anticonvulsant medication that is part of a patient’s home regimen influences outcomes in benzodiazepine-refractory convulsive status epilepticus.Methods:Using the Established Status Epilepticus Treatment Trial (ESETT) data, allocation to a study drug included in the patient’s home anticonvulsant medication regimen was compared to receipt of an alternative second-line study medication. The primary outcome was cessation of clinical seizures with improved consciousness by 60 minutes after study drug initiation. Secondary outcomes were seizure cessation adjudicated from medical records and adverse events. We performed inverse probability of treatment-weighted [IPTW] logistic regressions.Results:Of 462 patients, 232 (50%) were taking 1-2 of the 3 study medications at home. The primary outcome was observed in 39/89 (44%) patients allocated to their home medication versus 76/143 (53%) allocated to a non-home medication (IPTW odds ratio [OR] 0.66, 95% confidence interval [CI] 0.39-1.14). The adjudicated outcome occurred in 37/89 (42%) patients versus 82/143 (57%) respectively (IPTW OR 0.52, 95% CI 0.30-0.89). There was no interaction between study levetiracetam and home levetiracetam and there were no differences in adverse events.Conclusion:There was no difference in the primary outcome for patients who received a home medication versus non-home medication. However, the retrospective evaluation suggested an association between receiving a non-home medication and seizure cessation.Classification of Evidence:This study provides Class II evidence that for patients with refractory convulsive status epilepticus, use of a home second-line anticonvulsant compared to a non-home anticonvulsant did not significantly affect the probability of stopping seizures.

scholarly journals Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

The Lancet ◽  
2019 ◽  
Vol 393 (10186) ◽  
pp. 2125-2134 ◽  
Author(s):  
Mark D Lyttle ◽  
Naomi E A Rainford ◽  
Carrol Gamble ◽  
Shrouk Messahel ◽  
Amy Humphreys ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Randomised Trial ◽  
Convulsive Status Epilepticus ◽  
Line Treatment ◽  
Second Line ◽  
Open Label
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