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Convulsive status epilepticus (CSE) (box 1) is the most common childhood medical neurological emergency, with an incidence of approximately 20 per 100 000 per year in the developed world.1 2
Definition of status epilepticus
Status epilepticus is a condition resulting either from failure of the mechanism responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally prolonged seizures (after time point t1 at 5 min).
It is a condition, which can have long-term consequences (after time point t2 after 30 min) including neuronal death, neuronal injury and alteration of neuronal networks, depending on the type and duration of seizures.
CSE can be fatal, but mortality is lower in children than in adults—at about 2%–7%.3
Adverse neurological consequences following CSE consist of subsequent epilepsy, motor deficits, and learning and behavioural difficulties. The main determinant of outcome is the underlying aetiology (box 2). There is low risk of morbidity and mortality in children with unprovoked/prolonged febrile CSE. This risk increases significantly in cases with structural or genetic causes.
Common causes of status epilepticus
Known (ie, symptomatic)
Structural: Intracranial tumour, cerebrovascular
disease, head injury, cortical dysplasia
Infectious: CNS infection (meningitis, encephalitis), tuberculosis, cerebral malaria
Metabolic: Metabolic disturbance (electrolyte imbalance, glucose imbalance, organ failure, etc), metabolic disorders, anoxic injury, mitochondrial disorders
Toxicity or drug-related: Low or high level of antiseizure medication, withdrawal of antiseizure medication, other drug/alcohol overdose, neurotoxins and poisons
Inflammatory: Autoimmune disorders, neurocutaneous disorders
Genetic: Dravet syndrome, ring chromosome 20, Angelman syndrome, fragile X syndrome, Rett syndrome, trisomy 21
Unknown (ie, cryptogenic)
Information about the current guideline
The Advanced Life Support Group (ALSG) who run the Advanced Paediatric Life Support (APLS) programme provides internationally renowned guidance on the emergency management of common childhood emergencies. The APLS programme is also endorsed by the Royal College of Paediatrics and Child Health. Together, a professional …
Contributors The authors had multiple virtual meetings to create consensus for guideline. MB drafted the algorithm and article, other authors reviewed and edited. RA provided an independent critical appraisal of the guideline.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests AM: GW Pharma - Personal payment, Honorarium; UCB - Honorarium; LivaNova - support to attend meeting; BPNA - Trustee and Professional Support Officer; Epilepsy Scotland - Co-opted Board Member; Ring 20 - Medical Advisory Board Member. NM: Veriton Supply training materials to NM's organisation including demonstration kits of midazolam oromucosal solution for use in training simulations. RFMC: GW Pharma – personal payment, Honorarium, support to attend meeting, local principal investigator in clinical trials; UCB- Honorarium; Eisai – Honorarium, personal payment, support to attend meetings; Zogenix - Honorarium, personal payment, support to attend meetings; Shares in Rize Medical Cannabis & Life Sciences. RA: Chairman of the Independent Data Safety Monitoring Committee for an NIHR HTA-funded study on mental health in children with epilepsy (the ‘MICE’ Study). 2019 – ongoing. Voluntary role.
Provenance and peer review Not commissioned; externally peer reviewed.