Pediatric Management of Status Epilepticus

Status epilepticus in children is defined as a prolonged seizure or series of seizures without recovery of consciousness, typically lasting longer than five minutes. It represents a neurological emergency with potential for neuronal injury and systemic complications. Initial management prioritises rapid seizure termination, airway protection, cardiovascular support and identification of underlying causes. First-line treatment consists of prompt administration of weight-based benzodiazepines, most often intravenous lorazepam or, where intravenous access is delayed, buccal or intranasal midazolam. Should seizures persist beyond two benzodiazepine doses, second-line therapy with agents such as phenytoin, phenobarbital or levetiracetam is instituted. Refractory status epilepticus, defined by continued seizures despite first- and second-line drugs, demands escalation to continuous infusions (for example midazolam, propofol or ketamine) and intensive care monitoring. Concurrent investigations include metabolic panels, neuroimaging and electroencephalography to guide treatment and identify precipitants. Management must also address complications such as respiratory depression, hypotension and metabolic derangements. Multidisciplinary care pathways, including standardised emergency protocols and specialist training, have been shown to reduce treatment delays, improve drug delivery and enhance long-term neurological outcomes. In resource-limited settings adaptations may be required to ensure availability of essential antiseizure medications and critical care support. Globally, a combination of prompt pharmacological intervention, supportive measures and structured care pathways underpins effective paediatric management of status epilepticus.

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Pediatric Management of Status Epilepticus publication trend

The graph below shows the total number of articles in pediatric management of status epilepticus across all publications each year (not limited to Nature Index journals).

Technical terms

Status epilepticus: A neurological emergency defined by seizure activity lasting longer than five minutes or recurrent seizures without recovery between episodes.

Benzodiazepine: A class of first-line anticonvulsant drugs that potentiate γ-aminobutyric acid (GABA) inhibition to terminate acute seizures.

Refractory status epilepticus: A seizure that continues despite adequate administration of both first-line benzodiazepines and one second-line antiepileptic agent.

Second-line therapy: Antiepileptic medications such as phenytoin, phenobarbital or levetiracetam administered after benzodiazepines fail to halt status epilepticus.

Metabolomics: The large-scale analysis of small molecules in biological fluids to identify biomarkers indicative of disease processes or outcomes.

Prognostic biomarker: A biological indicator that predicts clinical trajectory or outcome in individuals with a particular condition.

References

1. Metabolomics of cerebrospinal fluid reveals prognostic biomarkers in pediatric status epilepticus. CNS Neuroscience & Therapeutics (2023).
2. Management of Status Epilepticus in Children. Journal of Clinical Medicine (2016).
3. A Comparison of Parenteral Phenobarbital vs. Parenteral Phenytoin as Second-Line Management for Pediatric Convulsive Status Epilepticus in a Resource-Limited Setting. Frontiers in Neurology (2019).
4. Identifying Barriers to Care in the Pediatric Acute Seizure Care Pathway. International Journal of Integrated Care (2022).
5. Reducing epilepsy diagnostic and treatment gaps: Standardized paediatric epilepsy training courses for health care professionals. Developmental Medicine & Child Neurology (2024).