First line management of prolonged convulsive seizures in children and adults: good practice points

  title={First line management of prolonged convulsive seizures in children and adults: good practice points},
  author={Liesbeth de Waele and Paul Boon and Berten Ceulemans and Bernard Dan and Anna C. Jansen and Benjamin Legros and Patricia Leroy and Françoise Delmelle and Michel Ossemann and Sylvie De Raedt and Katrien Smets and Patrick van de Voorde and Helene Verhelst and Lieven Lagae},
  journal={Acta Neurologica Belgica},
Over the past decades, it has become clear that the most efficient way to prevent status epilepticus is to stop the seizure as fast as possible, and early treatment of prolonged convulsive seizures has become an integral part of the overall treatment strategy in epilepsy. Benzodiazepines are the first choice drugs to be used as emergency medication. This treatment in the early phases of a seizure often implies a ‘pre-medical’ setting before intervention of medically trained persons. In this… 
First-line management of canine status epilepticus at home and in hospital-opportunities and limitations of the various administration routes of benzodiazepines
This narrative review provides an outline of the management of SE at home and in a hospital setting, discusses considerations and challenges of the various routes of BZD administration, and evaluates the impact of intranasal drug administration (nose-brain pathway) for controlling canine SE atHome and within hospital settings.
Timing and selection of first antiseizure medication in patients with pediatric status epilepticus
The view that delays in initial ASM administration are associated with prolonged SE in some patients is supported, indicating that not all prolonged seizures become refractory.
Management of epileptic seizures in school-age children: Educational project dedicated to school staff
An increase in knowledge of epilepsy, a better knowledge on management of acute seizures in the school settings, a reduction in anxiety, and an increase in willingness to administer rescue medications are documented.
Clobazam and clonazepam use in epilepsy: Results from a UK database incident user cohort study
Among adult and pediatric patients in the UK, CLB is more often prescribed for epilepsy than CZP, and the median CLB dosage remained stable over the 16-year study period, while the median CzP dosage increased in both adults and children.
Pediatric pre-hospital emergencies in Belgium: a 2-year national descriptive study
Pre-hospital pediatric EMS missions are not frequent and differ from the adult interventions, and the pediatric characteristics highlighted in this study should help EMS teams to be better prepared to deal with sick children in the pre-hospital setting.
Koortsconvulsies en epilepsie met koorts
Hannes is een 28 maanden oud jongetje dat op de spoedeisende hulp (seh) wordt aangeboden wegens convulsies (stuipen).


Clinical practice
  • L. Lagae
  • Medicine
    European Journal of Pediatrics
  • 2011
A generally accepted policy for early treatment of convulsive seizures is a crucial issue in the elaboration of an overall treatment plan for the child with epilepsy, and should include instruction and education of the parents and the caregivers surrounding the child.
Status epilepticus: pathophysiology and management in adults
The principles underlying the treatment of status epilepticus are reviewed and it is suggested that prehospital treatment is beneficial, that therapeutic drugs should be used in rapid sequence according to a defined protocol, and that refractory status epileptus should be treated with general anaesthesia.
Management of refractory status epilepticus in adults: still more questions than answers
To minimise intensive care unit-related complications, focal RSE without impairment of consciousness might initially be approached conservatively; conversely, early induction of pharmacological coma is advisable in generalised convulsive forms of the disorder.
Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study
The findings from a systematic, population-based study on the treatment of community-onset childhood CSE add to the debate on optimum emergency treatment of Childhood CSE and suggest that the current guidelines could be updated.
Inappropriate emergency management of status epilepticus in children contributes to need for intensive care
As the risk of respiratory depression is greater with more than two doses of benzodiazepines, clinicians should not disregard prehospital treatment of SE, and appropriate audit and modifications of standard guidelines are required.
Diagnostic work-up and therapeutic options in management of pediatric status epilepticus
Status epilepticus is the most common neurologic emergency in childhood and a systematic diagnostic work-up and a three steps based therapeutic approach is required at this age.
Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children.
This review provides no evidence to suggest that intravenous lorazepam should be preferred to diazepam as the first-line drug in treating acute tonic-clonic convulsions including convulsive status epilepticus in children, and there was some evidence from this review that rectal lorzepam may be more effective and safer than rectal diazepAM.
Benzodiazepines in epilepsy: pharmacology and pharmacokinetics
Among these BZDs, clorazepate has a unique profile that includes a long half‐life of its active metabolite and slow onset of tolerance, which could theoretically help minimize adverse events.
Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis.
Non-IV midazolam, compared to non-IV or IV diazepam, is safe and effective in treating SE, and comparison to lorazepam, evaluation in adults, and prospective confirmation of safety and efficacy is needed.
Intramuscular versus intravenous therapy for prehospital status epilepticus.
For subjects in status epilepticus, intramuscular midazolam is at least as safe and effective as intravenous lorazepam for prehospital seizure cessation.