Advances in Management Methods for Convulsive Status Epilepticus in Children: A Review of Iran Algorithms

Abstract

Context: As a common disorder, convulsive status epilepticus (CSE) in adults is second common and in children is most common neurological emergency. Morbidity of this condition such as difficulties of learning, de-novo epilepsy and neuro-disability, could be more than twenty two percent. The higher CSE duration led to higher difficulty to terminate this condition, and increase risk of morbidity. Evidence Acquisition: Convulsive status epilepticus is often managed by specific local or national algorithms. Treatment in first line is used when a focal motor clonic or tonic clonic seizure has duration more than five minutes (premonitory or impending CSE). In casese who CSE persisted with 2 first-line doses (difiened as CSE that is established), the second-line is administered. Different evidence of randomised clinical trial (RCT) supports benzodiazepines use as first-line drug. In addition alternative drugs, with less data of RCT studies, are intravenous clonazepam and intramuscular midazolam. Results: Up until 2019, phenytoin and phenobarbital were preferable second-line drug, but there are not significant RCT data about it. Also, lacosamide is alternative second-line agent but without supporting evidence from RCT studies. Current data showed that first, intravenous lorazepam or intranasal or buccal midazolam are most effective first-line drug to manage premonitory or impending CSE there are not diversity between effectiveness of phenytoin, sodium valproate or levetiracetam, for management of established CSE. Conclusions: In present review study, we give a general overview of status epilepticus and evaluate algorithms therapy in Iran.