Cohen Nathan T, Chamberlain James M, Gaillard William D
Division of Child Neurology, Children's National Health System, Washington, DC, United States; Division of Emergency Medicine, Children's National Health System, Washington, DC, United States.
Division of Emergency Medicine, Children's National Health System, Washington, DC, United States.
Epilepsy Res. 2019 Jan;149:21-25. doi: 10.1016/j.eplepsyres.2018.10.014. Epub 2018 Nov 1.
Pediatric status epilepticus (SE) may be associated with significant morbidity. We sought to evaluate timing and selection of antiseizure medications (ASM) in patients presenting in SE to a pediatric emergency department (ED). We hypothesized that delays in initial treatment are associated with longer overall duration of SE.
We identified patients with SE presenting to a single urban, academic pediatric hospital ED from 2009-2015. Patients were included in the study population with physician-documented ICD-9 code of SE. Medical record reviews were used to verify timing of seizure onset, ASM dosing, route, and timing.
141 patients had complete documentation to determine medication dosing and timing related to seizure onset. There were 75 boys and 66 girls. Median age was 45 months (IQR 20-97.5 months). Median overall duration of SE was 61.5 min (IQR 36-120 min). Median time to first ASM dose (whether given by parent, EMT or in ED) was 25 min (IQR 7-56 min). First dose ASM was a benzodiazepine (BDZ) in 92% of patients (130/141) and second-dose ASM was a BDZ in 95% of patients (90/95). Median seizure duration was 59.5 min and 151.5 min in patients who received first dose ASM in under 5 min and 60 min or more after seizure onset, respectively (p < 0.01). SE was stopped by first dose ASM in 32% of patients.
Our data suggest that there are delays in first dose ASM in patients presenting to our ED with SE. These results support the view that delays in initial ASM administration are associated with prolonged SE in some patients. A group of patients with prolonged SE had complete resolution after single dose of benzodiazepine, indicating that not all prolonged seizures become refractory.
小儿癫痫持续状态（SE）可能会导致严重的发病情况。我们试图评估在小儿急诊科（ED）就诊的SE患者中抗癫痫药物（ASM）的给药时间和选择。我们假设初始治疗的延迟与SE的总持续时间延长有关。
我们确定了2009年至2015年在一家城市学术性小儿医院急诊科就诊的SE患者。具有医生记录的SE的ICD-9编码的患者被纳入研究人群。通过病历审查来核实癫痫发作开始的时间、ASM给药剂量、途径和时间。
141例患者有完整的记录来确定与癫痫发作开始相关的药物剂量和时间。其中有75名男孩和66名女孩。中位年龄为45个月（四分位间距20 - 97.5个月）。SE的中位总持续时间为61.5分钟（四分位间距36 - 120分钟）。首次ASM给药的中位时间（无论由家长、急救医疗技术员还是在急诊科给药）为25分钟（四分位间距7 - 56分钟）。92%的患者（130/141）首次剂量的ASM是苯二氮䓬类药物（BDZ），95%的患者（90/95）第二次剂量的ASM是BDZ。癫痫发作开始后5分钟内和60分钟或更长时间接受首次剂量ASM的患者，癫痫发作的中位持续时间分别为59.5分钟和151.5分钟（p < 0.01）。32%的患者首次剂量的ASM就终止了SE。
我们的数据表明，在我们急诊科就诊的SE患者中，首次剂量ASM存在延迟。这些结果支持这样一种观点，即初始ASM给药的延迟在一些患者中与SE延长有关。一组SE持续时间延长的患者在单次给予苯二氮䓬类药物后完全缓解，这表明并非所有延长的癫痫发作都会变得难治。
