儿童原发性癫痫治疗指南(13)

儿童癫痫指南

IAP EXPERT COMMITTEE GUIDELINESDIAGNOSIS AND MANGEMENT OF EPILEPSY

Establish ABCs: Establish IV access, draw blood for laboratory investigations

IV glucose, calcium, or pyridoxine (in neonates and infants)

↓

IV Lorazepam 0.1 mg/kg

OR

IV diazepam 0.2 mg/kg followed by IV phenytoin/fosphenytoin

(If no IV access use PR diazepam 0.5 mg/kg or buccal/nasal/IM midazolam 0.2 mg/kg;

intraosseous access could be considered as a next step if IV still not available.)

↓

Repeat Lorazepam/ Diazepam once more SOS (5-10mins)

↓

IV fosphenytoin 20 PE (phenytoin equivalent)/kg/phenytoin 20 mg/kg(30 mins)(Consider transfer to PICU facilities as child at risk of refractory status)

↓

IV valproate (1:1 diluted NS 20-40 mg /kg over 1-5 minutes; given as continuous infusion at a rate of 5mg/kg/hr, if required.

OR

IV phenobarbital 15-20 mg/kg

(Re-assess airway again; consider tracheal intubation, if the

airway is compromised or the patient develops respiratory depression)(45-60 min)

↓

Transfer to a PICU set-up is mandatory as the child has refractory SE and will need intensive monitoring in

a tertiary PICU set up.

↓

Midazolam infusion (loading dose of 0.2 mg/kg, followed by 0.1 mg/kg/h titrate every 15 mins upwards by

0.05 mg/kg/h till control; maximum dose 2 mg/kg/h)

OR

Propofol infusion/ Pentothal infusion

(Propofol should not be routinely recommended in view of significant morbidity and mortality in children)

↓

General anesthesia if above steps fail(Tertiary hospital set-up essential)

In refractory status epilepticus needing coma producing therapies (Pentothal etc)

EEG monitoring preferably continuous should be used, if available. It should also be used if coma persists

despite control of convulsive status epilepticus (to exclude non convulsive status epilepticus)

FIG. 2 Management algorithm for status epilepticus.

REFERENCES

1.2.

Pal DK. Epilepsy control in the 21st century: leaveno child behind. Epilepsia 2003; 44: 273-275.Shiffman RN, Shekelle P, Overhage JM, Slutsky J,Grimshaw J, Deshpande AM. Standardized Repor-ting of Clinical Practice Guidelines: A proposalfrom the Conference on Guidelines Standardi-zation. Ann Intern Med 2003; 139: 493-498.

3.

Mizrahi EM, Watanabe K. Symptomatic neonatalseizures: In: Roger J, Bureau M. Epileptic Synd-romes in Infancy, Childhood and Adolescence, 4thed. London: John Libbey; 2005. p. 16-17.Bauder F, Wohlrab G, Schmitt B. Neonatalseizures: eyes open or closed. Epilepsia 2007; 48:394-396.

Co JP, Elia M, Engel J Jr, Guerrini R, Mizrahi EM,

4.

5.

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