Where and How Are the Initial Antiepileptic Drugs Administered to Children Who Develop Refractory Status Epilepticus? Results from the Pediatric Status Epilepticus Research Group (pSERG) (P3.006)

OBJECTIVE: To describe the settings and administration routes of the initial antiepileptic drugs (AEDs) given to children with refractory convulsive status epilepticus. BACKGROUND: Non-intravenous administration routes have been demonstrated to be comparable to classical intravenous route. DESIGN/METHODS: Multicenter prospective cohort study. We described the setting and administration route of the initial AEDs given to children with refractory convulsive status epilepticus. Inclusion criteria: 1) admitted between June 2011 and September 2013, 2) age from 1 month to 21 years, 3) convulsive seizures at onset, and 4) failure of 蠅 2 AEDs to terminate seizures or the initiation of a continuous infusion of medications for seizure control. RESULTS: 105 cases (54 males) with a mean (SD) age of 5.6 (5.3) years were enrolled. 74 episodes (70.5%) started out of the hospital. The first AED drug was a benzodiazepine in 100 episodes (95.2%) [60 lorazepam, 28 diazepam, 10 midazolam, clobazam in 2]. Other five cases included intravenous phosphenytoin (n=2), phenobarbital (n=1) and levetiracetam (n=1). The route of administration was 1) intravenous in 81 episodes (77.1%), 2) rectal in 21 episodes (20%) (17 of those started out of the hospital and four started in the hospital; in 7 episodes the rectal medication was given by the family, in 5 episodes by the emergency medical services and in 9 episodes by the hospital personnel), 3) intramuscular in one episode (1%) that started out of the hospital and was treated in the hospital and 4) intranasal and buccal in one episode each and administered by the family in both cases. CONCLUSIONS: Refractory convulsive status epilepticus starts more frequently in the out-of-hospital setting, yet non-venous routes such as intramuscular, nasal or buccal, which may be easier to administer and not inferior to the intravenous route, are underutilized by families and emergency medical services. Study supported by: Epilepsy Foundation of America and American Epilepsy Society Infrastructure Award Disclosure: Dr. Sanchez Fernandez has nothing to disclose. Dr. Abend has nothing to disclose. Dr. Agadi has nothing to disclose. Dr. Arya has nothing to disclose. Dr. Basu has nothing to disclose. Dr. Carpenter has nothing to disclose. Dr. Chapman has nothing to disclose. Dr. Dean has nothing to disclose. Dr. Gaillard has received personal compensation for activities with King Pharmaceutical as a member of an advisory board, and Questcor. Dr. Glauser has received personal compensation for activities with Supernus, Sunovion Pharmaceuticals, Eisai Inc., UCB Pharma, Lundbeck, Questcor, Upsher-Smith, AssureRx Health, and GeneDx. Dr. Glauser has received royalty, or license fee, or contractual rights payments from AssureRx Health. Dr. Goodkin has received personal compensation in an editorial capacity for Up To Date. Dr. Jackson has nothing to disclose. Dr. Mikati has nothing to disclose. Dr. Peariso has nothing to disclose. Dr. Rathore has nothing to disclose. Dr. Tasker has nothing to disclose. Dr. Topjian has nothing to disclose. Dr. Turner has nothing to disclose. Dr. Wilfong has received personal compensation for activities with Cyberonics and Eisai Inc. as a speaker, and Cyberonics and Lundbeck as a consultant. Dr. Wilfong has received research support from Cyberonics, Moody Foundation, Eisai Inc., Pfizer Inc., and Novartis. Dr. Williams has nothing to disclose. Dr. Loddenkemper has received personal compensation in an editorial capacity for Seizure. Dr. Loddenkemper has received research support from the National Institutes of Health, the Payer Provider Quality Initiative, The Epilepsy Foundation of America, the Center for Integration of Medicine and Innovative Technology, the Epilepsy Therapy Project, the American Epilepsy Society, The Pediatric Epilepsy Research Foundation, Cure, Lundbeck Research USA, Inc., and Eisai Inc.