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. 2022 Mar 5;22(1):77.
doi: 10.1186/s12883-022-02608-2.

Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children

Shoichi Tokumoto  1   2 , Masahiro Nishiyama  3 , Hiroshi Yamaguchi  3 , Kazumi Tomioka  3 , Yusuke Ishida  4   5 , Daisaku Toyoshima  4 , Hiroshi Kurosawa  6 , Kandai Nozu  3 , Azusa Maruyama  4 , Ryojiro Tanaka  5 , Kazumoto Iijima  3 , Hiroaki Nagase  3
Affiliations

Prognostic effects of treatment protocols for febrile convulsive status epilepticus in children

Shoichi Tokumoto et al. BMC Neurol. .

Abstract

Background: Febrile status epilepticus is the most common form of status epilepticus in children. No previous reports compare the effectiveness of treatment strategies using fosphenytoin (fPHT) or phenobarbital (PB) and those using anesthetics as second-line anti-seizure medication for benzodiazepine-resistant convulsive status epilepticus (CSE). We aimed to examine the outcomes of various treatment strategies for febrile convulsive status epilepticus (FCSE) in a real-world setting while comparing the effects of different treatment protocols and their presence or absence.

Methods: This was a single-center historical cohort study that was divided into three periods. Patients who presented with febrile convulsive status epilepticus for ≥60 min even after the administration of at least one anticonvulsant were included. During period I (October 2002-December 2006), treatment was performed at the discretion of the attending physician, without a protocol. During period II (January 2007-February 2013), barbiturate coma therapy (BCT) was indicated for FCSE resistant to benzodiazepines. During period III (March 2013-April 2016), BCT was indicated for FCSE resistant to fPHT or PB.

Results: The rate of electroencephalogram monitoring was lower in period I than period II+III (11.5% vs. 85.7%, p<0.01). Midazolam was administered by continuous infusion more often in period I than period II+III (84.6% vs. 25.0%, p<0.01), whereas fPHT was administered less often in period I than period II+III (0% vs. 27.4%, p<0.01). The rate of poor outcome, which was determined using the Pediatric Cerebral Performance Category scale, was higher in period I than period II+III (23.1% vs. 7.1%, p=0.03). The rate of poor outcome did not differ between periods II and III (4.2% vs. 11.1%, p=0.40).

Conclusions: While the presence of a treatment protocol for FCSE in children may improve outcomes, a treatment protocol using fPHT or PB may not be associated with better outcomes.

Keywords: Anticonvulsant; Barbiturate; Benzodiazepine; Clinical protocol; Febrile seizure; Phenytoin.

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Conflict of interest statement

The authors have no financial relationships relevant to this article to disclose. Potential conflicts of interest: Kazumoto Iijima has received grants from Eisai Co., Ltd, and consulting fees from Takeda P Pharma Co., Ltd.; Kandai Nozu has received consulting fees from Eisai Co., Ltd, and lecture fees from Sumitomo Dainippon Pharma Co., Ltd. There is no potential conflict of interest by the rest of the authors.

Figures

Fig. 1
Fig. 1
Treatment protocol for each period. BZP: benzodiazepine, DZP: diazepam, MDL: midazolam, FCSE: febrile convulsive status epilepticus, fPHT: fosphenytoin, PB: phenobarbital, BCT: barbiturate coma therapy, TTM: targeted temperature management, iv: intravenous, im: intramuscular, ci: continuous infusion, EEG: electroencephalogram.
Fig. 2
Fig. 2
Selection of patients. The flowchart details the patient selection procedure. FCSE: febrile convulsive status epilepticus
See this image and copyright information in PMC

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