Zanus Caterina, Cannizzaro Giulia, Danieli Giacomo, Amigoni Angela, Buratti Silvia, Izzo Francesca, Mastrangelo Massimo, Mondardini Maria Cristina, Costa Paola, Rosati Anna, Marini Carla, Fusco Lucia
Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" -, Trieste, Italy.
Paediatric Neurology Unit, Meyer Children's Hospital IRCCS, University of Florence, Florence, Italy.
Brain Behav. 2025 Apr;15(4):e70433. doi: 10.1002/brb3.70433.
To explore specialists' opinions on the current management of pediatric convulsive status epilepticus (CSE) in Italy and the main factors influencing the applicability of guidelines.
We conducted a national survey of child neurologists, pediatric emergency physicians, and intensivists. Within the multidisciplinary Italian Paediatric Status Epilepticus (IPSE) Group, a web-based 48-multiple-choice questionnaire was developed to explore treatment choices, use of internal protocols and guidelines, and self-perceived competencies in the treatment of CSE.
Responses were received from 250 clinicians from 34 Italian hospitals (response rate 71%). Intravenous midazolam (iv-MDZ) was the preferred benzodiazepine (BDZ) when iv access was available (90%). When iv-access was unavailable, 75% of clinicians used BDZs; rectal diazepam was the most indicated (65.6%). Concerning second-line treatment, the choices were equally distributed between phenytoin (55.2%), levetiracetam (52.4%), and phenobarbital (52.4%). MDZ infusion at a dosage < 0.23 mg/kg/h was also a frequent choice (38%). A PICU in the hospital influenced this latter choice, resulting in a significantly greater use of iv-MDZ by pediatric emergency physicians working in these hospitals. Answers' variability was related to organizational aspects such as the availability of on-duty specialists and diagnostic tools in emergency settings.
This survey confirmed that first-line treatment of pediatric CSE relied on iv-MDZ and that the heterogeneity of therapeutic choices started from the second-line treatment in real life. The survey also highlighted the need to consider the organizational heterogeneity among settings and to involve different specialties in an integrated and feasible approach.
探讨意大利专家对当前小儿惊厥性癫痫持续状态（CSE）管理的看法以及影响指南适用性的主要因素。
我们对儿童神经科医生、儿科急诊医生和重症监护医生进行了一项全国性调查。在多学科的意大利小儿癫痫持续状态（IPSE）小组内，设计了一份基于网络的48道多项选择题问卷，以探讨治疗选择、内部协议和指南的使用情况以及在治疗CSE方面的自我认知能力。
收到了来自意大利34家医院的250名临床医生的回复（回复率71%）。当有静脉通路时，静脉注射咪达唑仑（iv-MDZ）是首选的苯二氮䓬类药物（BDZ）（90%）。当没有静脉通路时，75%的临床医生使用BDZ；直肠用安定是最常用的（65.6%）。关于二线治疗，选择在苯妥英钠（55.2%）、左乙拉西坦（52.4%）和苯巴比妥（52.4%）之间平均分布。剂量<0.23mg/kg/h的MDZ输注也是一个常见的选择（38%）。医院里有儿科重症监护病房（PICU）影响了后一种选择，导致在这些医院工作的儿科急诊医生更多地使用静脉注射MDZ。答案的变异性与组织方面有关，如急诊环境中值班专家和诊断工具的可用性。
这项调查证实，小儿CSE的一线治疗依赖于静脉注射MDZ，并且在现实生活中，治疗选择的异质性从二线治疗开始。该调查还强调了需要考虑不同环境之间的组织异质性，并以综合且可行的方法让不同专业参与进来。
