PHILADELPHIA—Continuous IV therapy may not be appropriate for all children with drug-resistant status epilepticus, according to research presented at the 69th Annual Meeting of the American Epilepsy Society. The treatment is associated with more pediatric ICU (PICU) interventions and a longer length of hospital stay.
Kevin Chapman, MD, Associate Professor of Neurology at Children’s Hospital Colorado in Aurora, and colleagues prospectively studied 111 children treated for refractory status epilepticus at nine tertiary pediatric hospitals in the United States from June 2011 to June 2013. Eligible participants included children between ages 1 month and 21 years with initial convulsive seizures. For all participants, two or more antiepileptic drugs (AEDs) failed to stop the seizures, or continuous IV infusions were initiated. The investigators collected data about first- and second-tier AEDs and use of continuous IV infusions. Seizures were classified as continuous or intermittent.
Approximately half of patients received continuous IV infusions, and these patients did not differ from those who received AED boluses in terms of age, sex distribution, ethnicity, or known epilepsy. All patients were admitted to a PICU and remained for a median of three days. The percentage of status epilepticus that started out of the hospital among children who later received continuous IV infusions (69%) was no different from that among children who later received boluses of AEDs (65%). The mean duration of convulsive seizures in all patients was 141 minutes. The researchers found no significant difference in seizure duration between children receiving continuous infusions and those receiving AED boluses (162 minutes vs 123.5 minutes).
Nearly 86% of patients had a status epilepticus duration of longer than 30 minutes in the hospital. Among these patients, the interval to seizure cessation was longer in children receiving continuous IV infusion, compared with children who received AED boluses (155 minutes vs 110.5 minutes). Hypotension and the use of vasopressors were more frequent in continuous IV infusion therapy. The length of PICU stay was increased in patients receiving continuous IV infusion therapy, compared with those who received AED boluses (10 days vs two days), despite a similarity in the proportion of patients who were mechanically ventilated.
“Given these variations in response and morbidity, continuous IV therapy may not be appropriate for all patients with drug-resistant status epilepticus,” Dr. Chapman concluded.
—Erik Greb