وصف
Prompt and effective management of status epilepticus in children is critical to prevent neurological complications and long-term sequelae. Initial management involves ensuring the child's safety and stabilizing vital signs, followed by rapid administration of antiepileptic medications. Benzodiazepines such as lorazepam or midazolam are first-line agents for terminating seizures and preventing progression to status epilepticus. If seizures persist, second-line agents such as phenytoin, fosphenytoin, or levetiracetam may be administered intravenously to achieve seizure control. In refractory cases, continuous infusions of anesthetic agents such as midazolam or propofol may be initiated in the intensive care unit. Timely neuroimaging studies may be indicated to rule out structural abnormalities or identify potential reversible causes of status epilepticus.
ملخص
- Status epilepticus is a neurological emergency in children, potentially leading to morbidity and mortality. Early home stabilization and timely emergency room management are crucial for meaningful survival and preventing neurological damage. Initial stabilization focuses on airway, breathing, and circulation (ABC), followed by treatments targeting seizures, intracranial pressure, and reversible causes.
- Benzodiazepines are the first-line drugs, while fosphenytoin, levetiracetam, and valproate serve as second-line options. Neuroprotection checklists are essential to prevent secondary brain damage. Continuous seizures lasting over five minutes necessitate intervention, as neuronal damage can occur rapidly.
- Causes of status epilepticus can be cryptogenic (unknown) or symptomatic, with acute symptomatic causes being most common. Pathophysiology involves an imbalance between GABA (inhibitory) and glutamate (excitatory) neurotransmitters. A team approach in ICU settings, with trained personnel familiar with basic and advanced life support, is vital.
- Pharmacotherapy involves rapid administration of benzodiazepines, followed by phenytoin or fosphenytoin if seizures persist. Refractory cases require levetiracetam, valproate, or phenobarbital. Continuous EEG monitoring is essential to assess treatment effectiveness.
- Complications of prolonged seizures include cardiovascular, pulmonary, renal, autonomic, and metabolic disturbances. Long-term outcomes may involve cognitive decline, epilepsy, and neurological deficits. Early referral to a pediatric neurologist is crucial for managing and preventing recurrent seizures.
- Health education for families with children prone to seizures is essential, including training in rescue medication administration. Precautions such as avoiding swimming, cycling, or open flames are important to minimize risks.
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