Advances in Management Methods for Convulsive Status Epilepticus in Children: A Review of Iran Algorithms

Context: 

As a common disorder, convulsive status epilepticus (CSE) in adults is second common and in children is most common neurological emergency. Morbidity of this condition such as difficulties of learning, de-novo epilepsy and neuro-disability, could be more than twenty two percent. The higher CSE duration led to higher difficulty to terminate this condition, and increase risk of morbidity.

Evidence Acquisition: 

Convulsive status epilepticus is often managed by specific local or national algorithms. Treatment in first line is used when a focal motor clonic or tonic clonic seizure has duration more than five minutes (premonitory or impending CSE). In casese who CSE persisted with 2 first-line doses (difiened as CSE that is established), the second-line is administered. Different evidence of randomised clinical trial (RCT) supports benzodiazepines use as first-line drug. In addition alternative drugs, with less data of RCT studies, are intravenous clonazepam and intramuscular midazolam.

Up until 2019, phenytoin and phenobarbital were preferable second-line drug, but there are not significant RCT data about it. Also, lacosamide is alternative second-line agent but without supporting evidence from RCT studies. Current data showed that first, intravenous lorazepam or intranasal or buccal midazolam are most effective first-line drug to manage premonitory or impending CSE there are not diversity between effectiveness of phenytoin, sodium valproate or levetiracetam, for management of established CSE.

In present review study, we give a general overview of status epilepticus and evaluate algorithms therapy in Iran.