Management of the child

Seek expert guidance.

The management of status epilepticus in the child entails:

• an airway should be maintained and oxygen given.
• place in semi-prone position and protect against self- injury or over zealous restraint.
• test for hypoglycaemia and treat if present. Take blood for U + E 's, Ca, Mg and glucose.

With regards to drug management, a systematic review has been undertaken:

• (1) Intravenous lorazepam is at least as effective as and safer than intravenous diazepam in children
  • associated with fewer adverse events in the treatment of acute tonic-clonic convulsions
• (2) Buccal midazolam is more effective than rectal diazepam in children in the emergency management of convulsive seizures
  • evidence supports the use of buccal midazolam as the first line treatment of acute tonic-clonic seizures in childhood including convulsive status epilepticus where intra-venous access in unavailable
• (3) Intranasal lorazepam is more effective (less likely to require additional drugs to terminate seizure), safer and cheaper than intramuscular paraldehyde in the treatment of acute tonic clonic seizures

Reference:

• 1. Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001905.