Treatment of convulsive status epilepticus in the UMCG; a retrospective, observational study.

Vlaskamp, D.R.M. (Danique) (2013) Treatment of convulsive status epilepticus in the UMCG; a retrospective, observational study. thesis, Medicine.

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Abstract

Background: Convulsive Status Epilepticus (CSE) is a medical emergency associated with high mortality and morbidity. Because a longer duration is associated with poor outcome, treatment is important to reduce seizure length. However, there is no golden standard yet for the treatment of CSE in childhood. Furthermore, little is known about what happens in clinical practice with respect to treatment of CSEs. Objectives: The primary objective of this retrospective, observational study was to evaluate the course of CSEs and its treatment regimes in the University Medical Centre of Groningen (UMCG). The secondary objective was to evaluate effectiveness and safety of each administered therapy. Material and methods: All children with a positive history of a febrile or non-febrile CSE were selected from a UMCG database that included all children with a first epileptic seizure or febrile convulsion before the age of 18 occurring between January 2000 and January 2010 and who were treated in the UMCG. After retrospective evaluation of their medical files, all CSEs occurring in children older than 1 month between January 2000 and October 2012 were included in this study. CSEs were excluded if no information was available about any administered therapy. Medical-files of children with included CSEs were retrospectively evaluated for parameters concerning the children themselves, their CSEs and its treatment. Results: Treatment regimes of 269 CSEs (43.9% remote symptomatic), occurring in 69 children (54.6% men, median age 4 years and 2 months), were evaluated. For cessation of CSEs, a median sum of 2.0 administrations of any therapy was needed (range 0-10, range of different therapies 0-5). Children with a CSE of acute or acute on remote symptomatic aetiology needed significantly more administrations of (different) therapies before the CSE stopped (p<0.05). Furthermore, treatment of CSEs in the presence of an individualized treatment protocols was associated with shorter total categorized duration of CSEs (p=0.002). Evaluation of treatment regimes showed that diazepam was preferred, followed by clonazepam, midazolam and phenytoin. No significant differences regarding effectiveness of these therapies were observed. Discussion and conclusion: This study highlights new fields of interest regarding an optimal treatment regime of CSEs in childhood. Treatment in the UMCG was overall in accordance with Dutch protocols and supported by evidence for efficacy in literature, except for the use of clonazepam. The use of clonazepam should therefore be reconsidered. Furthermore, further research should also focus on differences in pharmacoresistance between subtypes of CSEs, based on aetiology, and on the implementation of individualized treatment protocols in CSEs in childhood.

Item Type:	Thesis (Thesis)
Supervisor name:	Tijink-Callenbach, Dr. P.M.C.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2710

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