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A Journal on Psychiatry, Psychology and Psychopharmacology
Official Journal of the Italian Society of Social Psychiatry
Indexed/Abstracted in: EMBASE, e-psyche, PsycINFO, Scopus, Emerging Sources Citation Index
Minerva Psichiatrica 2006 September;47(3):243-8
Clinical and pharmacological approaches of status epilepticus in children: personal experience
Franzoni E. 1, Bracceschi R. 1, Colonnelli M. C. 1, Errani A. 1, Ucchino V. 1, Garone C. 1, Sarajlija J. 1, Verrotti A. 2, Gentili A. 3, Pigna A. 3
1 Unit of Child Neuropsychiatry Department of Paediatrics University of Bologna, Bologna, Italy
2 Section of Paediatrics Department of Medicine University of Chieti, Chieti, Italy
3 Intensive Care Unit Department of Paediatrics S. Orsola-Malpighi Hospital Bologna, Italy
Aim. Status epilepticus (SE) is a neurological emergency that requires a prompt treatment following steps of more aggressive therapy. We analysed efficacy of treatment protocol in paediatric SE.
Methods. We present a retrospective study in 29 patients (age range: 3 months-18 years) affected by SE of whom 16 patients had a previous diagnosis of epilepsy (symptomatic or idiopathic) while, in 13 cases, SE was the first epileptic event. Protocol of treatment suggests a first treatment with intravenous diazepam followed by a bolus of phenytoin (PHT) in case of nonresponse. All patients were carefully monitored, electroencephalographic (EEG) activity and vital signs, particularly respiratory depression. When the patients were classified as refractory or suffered from respiratory insufficiency, they were transferred into intensive care unit (ICU) where anesthetic drugs (propofol or pentothal) could be administered.
Results. Seventeen children were treated in neurological unit: 7 (24%) children responded to intravenous diazepam. Ten (35%) children required an additional bolus of phenytoin at the variable dose of 15-20 mg/kg/bolus. Twelve patients (41%) were admitted to ICU: 3 for respiratory insufficiency and 9 for treatment with anaesthetics drugs.
Conclusion. In our experience so as in literature there is no gold standard in the treatment of SE. Nearly half of patients needed ICU support thus, the best approach still remains multidisciplinary.