protocol for management of status epilepticus in a child

Last reviewed 01/2018

Consult expert advice and local guidelines. An example protocol is provided below (1):

guidelines for treating convulsive status epilepticus in children in hospital setting

• following protocol for treating convulsive status epilepticus (CSE) is presented as an example.

This protocol does not include infants, those born very prematurely and/or less than 28 days of age or children who have frequent episodes of CSE (for whom an individually tailored guideline is the best option).

• 1st step (0 minutes) - seizure starts
  • confirm clinically that it is an epileptic seizure
  • check ABC
  • high flow O2 if available
  • check blood glucose

• 2nd step (5 minutes)
  • midazolam 0.5 mg/kg buccally (Midazolam may be given by parents, carers or ambulance crew in non-hospital setting) or
  • lorazepam 0.1 mg/kg if intravenous access established

• 3rd step (15 minutes)
  • lorazepam 0.1 mg/kg intravenously
  • this step should be in hospital, call for senior help
  • start to prepare phenytoin for 4th step
  • re-confirm it is an epileptic seizure

• 4th step (25 minutes)
  • phenytoin 20 mg/kg by intravenous infusion over 20 mins or (if on regular phenytoin)
  • phenobarbital 20 mg/kg intravenously over 5 mins
  • note that paraldehyde 0.8 ml/kg of mixture may be given after start of phenytoin infusion as directed by senior staff
  • inform intensive care unit and/or senior anaesthetist

• 5th step (45 minutes)
  • rapid sequence induction of anaesthesia using thiopental sodium 4 mg/kg intravenously
  • transfer to paediatric intensive care unit

treatment of non convulsive status epilepticus

Less common and treatment is less urgent when compared to convulsive SE.

The following treatment should be considered in adults and children with non convulsive SE (1):

• maintenance or reinstatement of usual oral AED therapy
• use of intravenous benzodiazepines under EEG control, particularly if the diagnosis is not  established
• referral for specialist advice and/or EEG monitoring

Reference:

• (1) National Clinical Guideline Centre (NCGC) 2012. The Epilepsies. The diagnosis and management of the epilepsies in adults and children in primary and secondary care.