Pediatric Status Epilepticus: A Primer
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Pediatric Status Epilepticus: A Primer
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Status epilepticus has been redefined from 30 minutes to just 5 minutes of continuous seizure activity, aligning better with current treatment approaches that emphasize early intervention. This includes recognizing non-convulsive status, which often presents as a prolonged postictal state with subtle eye movements or gaze deviation.
• Systematic assessment includes history of seizures, medications, shunts, trauma, potential ingestions
• Lab evaluation should include glucose, electrolytes, calcium, pregnancy testing when applicable
• Initial treatment involves two doses of benzodiazepines via IV, rectal, buccal, or intranasal routes
• Simplified dosing: midazolam/diazepam 0.2 mg/kg (max 10mg); lorazepam 0.1 mg/kg (max 4-5mg)
• Second-line agents include levetiracetam (60 mg/kg), fosphenytoin (20 PE/kg), or valproate
• For refractory status, consider ketamine, phenobarbital, or continuous infusions after intubation
• Propofol is generally avoided in children under age 3 and carries risk of propofol infusion syndrome
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