Delayed benzodiazepine treatment in pediatric patients with refractory convulsive status epilepticus (RCSE) is associated with increased mortality, increased frequency of hypotension, and other negative effects, according to a study published in JAMA Neurology.
Marina Gaínza-Lein, BS, a research fellow in the Division of Epilepsy and Clinical Neurophysiology, of the Department of Neurology at Boston Children’s Hospital and Harvard Medical School, and associates conducted an observational group study to determine if first-line benzodiazepine usage was affiliated with adverse events in pediatric patients with RCSE when used as a primary treatment.
The primary observed outcome was mortality at the time associated with hospital admission. The secondary observed outcome was the requirement for further infusion for seizure expiration.
In the multicenter study, 218 pediatric patients with RCSE were involved (53.2%, male; median age, 4 years). Of the cohort, 139 patients had pre-hospital RCSE. All patients were grouped to receive a benzodiazepine in either less than 10 minutes (74 patients) or more (144 patients).
Patients receiving ill-timed treatments had greater odds for mortality (adjusted odds ratio, 11.0) and requirement for further infusion (AOR, 1.8). In addition, a greater length of convulsive seizure and increased rate of hypotension was observed in the ill-timed treatment group (AOR; 2.6 and 2.3, respectively).
Mortality was observed exclusively in the ill-timed treatment group (n=7) pre-hospital discharge. Of these patients, 71.4% had status epilepticus (SE) onset before hospital admission.
The investigators observed that first-line benzodiazepine treatment was significantly associated with second- and third-line antiseizure medications.
“Many of the available studies on SE treatment and outcome are based on adult populations, and this cohort permitted us to fill some gaps in the literature,” the authors reported. “The large sample size allowed us to study both common and rare outcomes and to demonstrate new associations that will affect the treatment of SE.”
- Gaínza-Lein M, Sánchez Fernández I, Jackson M, et al. Association of time to treatment with short-term outcomes for pediatric patients with refractory convulsive status epilepticus. JAMA Neurol. 2018 Jan 22. doi:10.1001/jamaneurol.2017.4382