Characteristics of withdrawal seizures in children with refractory status epilepticus who responded favorably to continuous midazolam therapy.

BACKGROUND

This study investigates the characteristics of children with refractory status epilepticus (RSE) who experienced withdrawal seizures and responded favorably to continuous midazolam (cMDL) therapy.

METHODS

Patients who experienced RSE and achieved seizure cessation with cMDL were included in the study. Withdrawal seizure was defined as a seizure occurring from the initiation of cMDL tapering until 48 h after the discontinuation of cMDL. The patients were categorized into two groups: seizure cessation and withdrawal seizure groups.

RESULTS

Nineteen patients with RSE achieved seizure cessation with cMDL. The seizure cessation group comprised 11 patients, while eight patients (42.1 %) were classified into the withdrawal seizure group. The median maintenance dose of cMDL were 0.1 mg/kg/h (interquartile range [IQR]: 0.1-0.2) for the seizure cessation group, and 0.25 mg/kg/h (IQR: 0.15-0.3) for the withdrawal seizure group. The median maintenance periods were 27 h (IQR: 12-32.5) for the seizure cessation group, and 52.5 h (IQR: 23-65.5) for the withdrawal seizure group. The seizure cessation group had a median cumulative MDL of 2.7 mg/kg (IQR: 1.6-4.9), while the withdrawal seizure group had 11.6 mg/kg (IQR: 4.5-24.5).

CONCLUSION

Although statistical analysis was not conducted due to the small sample size, maintenance dose of cMDL is potentially correlated with withdrawal seizure. A multi-center study with large sample size and statistical analysis of this relationship may contribute to the establishment of an optimized cMDL tapering protocol.