TREATMENT OF STATUS EPILEPTICUS IN INFANCY AND EARLY CHILDHOOD

Abstract

The problem of status epilepticus (SE) in infancy and early childhood is very important due to a high occurrence of SE, serious consequences of prolonged seizures for the child's developing brain, atypical variants of SE accompanying specific age-dependant forms of epilepsy in the first year of life (infantile epileptic encephalopathies), high rate of pharmacoresistant forms and severe disability of patients. Out of the total of 407 pediatric patients with revealed cases of SE 267 children had the SE onset before 3 years of age (65,6%), and 147 patients (36,1%) had SE onset in infancy. In the structure of ES at infancy and early childhood 38,6% of cases were represented by epileptic encephalopathies, 27% — by focal forms of epilepsy, 15,7% — hereditary neurodegenerations, 14,2% — acute symptomatic SE and 4,5% — isolated febrile SE. SE in infancy was treated with benzodiasepines — diazepam (0,5 mg/kg per rectum, i. m. or i. v.), midazolam (0,15–0,4 mg/kg i. v. in bolus, supporting infusion — 1–3 µg/kg/min), and valproates (convulex) in the initial dose of 10–25 mg/kg followed by a supporting infusion of 1–4 mg/kg/hour. The refractory cases of SE were treated with sodium oxybate (100–150 mg/kg with the speed of 400 mg/min), propofol (3 mg/kg i. v. in bolus followed by a supporting infusion — 100 µg/kg/min), sodium thiopental (4 mg/kg followed after 2 minutes by an infusion of 0,2 mg/kg/min).