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An update in the initial management of paediatric status epilepticus

Lawton, Bena,b,c; Davis, Tessad; Goldstein, Henrya,b; Tagg, Andrewe

Current Opinion in Pediatrics: June 2018 - Volume 30 - Issue 3 - p 359–363
doi: 10.1097/MOP.0000000000000616
EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean Klig and Clifford W. Bogue
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Purpose of review Over the last 2 years, algorithms for the optimal management of status epilepticus have changed, as the medical community has recognized the need to terminate seizures in status in a timely manner. Recent research has evaluated the different choices of benzodiazepine and has given consideration to second-line treatment options.

Recent findings There has been a move to examine alternatives to phenytoin (such as levetiracetam and lacosamide) as second-line agents. Valproate should be used cautiously in view of the potential side effects. Three ongoing trials [Established Staus Epilepticus Treatment Trial (ESETT), Convulsive Status Epilepticus Paediatric Trial (ConSEPT), and emergency treatment with levetiracetam or phenytoin in status epilepticus in children (EcLiPSE)] are comparing the efficacy of levetiracetam and phenytoin.

Summary Benzodiazepines remain the first-line agent of choice, although there is ongoing discussion about the mode of administration and the best drug to choose. The results of ESETT, ConSEPT, and EcLiPSE will affect our future management of status, as we give consideration to levetiracetam as an alternative to phenytoin. Other medications such as lacosamide may emerge in future algorithms too.

aEmergency Department, Lady Cilento Children's Hospital, South Brisbane

bEmergency Department, School of Medicine, University of Queensland, St Lucia

cEmergency Department, Logan Hospital, Meadowbrook, Queensland, Australia

dEmergency Department, Royal London Hospital, London, UK

eEmergency Department, Footscray Hospital, Melbourne, Victoria, Australia

Correspondence to Ben Lawton, BSc (Hons), MBChB, FRACP (PEM), Emergency Department, Logan Hospital, Armstrong Rd. & Loganlea Rd., Meadowbrook 4131, QLD, Australia. E-mail: ben.lawton@yahoo.com

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