Pediatric emergency medicine trisk 1445 1445
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(e.g., pentobarbital 5 to 15 mg/kg load, then 1 mg/kg/hr starting dose),
benzodiazepines (e.g., continuous infusion midazolam 0.2 mg/kg load, then 0.05
to 0.2 mg/kg/hr), or continuous infusion propofol (3 to 5 mg/kg load, then 1 to 15
mg/kg/hr).
Patients requiring general anesthetics need to be intubated (if not already done)
and need continuous EEG monitoring. The level of anesthesia should be titrated
to maintain either a flat-line or burst-suppression pattern on the EEG. The
anesthesia can be then withdrawn slowly to see if any electrical seizure activity
persists.
It is important to note that prior CNS insult or seizure disorder accounts for a
high proportion of pediatric status epilepticus cases. Seizure management may be
very complex and may involve multiple AEDs; therefore, a seizure management
plan should be developed as rapidly as possible in consultation with a pediatric
neurologist, either preemptively or during an SE episode.
SPECIAL CONSIDERATIONS
Febrile Seizures
Febrile seizures are the most common convulsive disorder in young children,
occurring in 2% to 5% of the population. Most clinicians define a febrile seizure
as a seizure occurring between 6 months and 5 years of age that is associated with
a fever (temperature higher than 38°C [100.4°F]), but without the evidence of
intracranial infection or other defined cause or neurologic disease. Some
clinicians use 7 years as an upper age limit for febrile seizures, following the
International League Against Epilepsy (ILAE) from 1993 defining the age cutoff
of 1 month to 7 years.
Febrile seizures can be of any type, but most commonly, they are generalized
tonic-clonic seizures. They are usually self-limited and last for only a few
minutes. Febrile seizures are classified as simple when lasted less than 15
minutes, are generalized, and occur only once during a 24-hour period (two
seizures within a time period of <30 minutes will be considered a single episode).
In contrast, complex febrile seizures are prolonged, recur within 24 hours, or have
focal manifestations. Simple febrile seizures (85%) are much more common.
There is a family history of febrile seizures in an immediate family member in
25% to 40% of cases. Viral infections are frequently associated with febrile
seizures, and human herpesvirus is a commonly identified agent.
After the first febrile seizure, approximately 33% of patients will have at least
one recurrence and about 9% will have three or more episodes. The younger the
