Time from convulsive status epilepticus onset to anticonvulsant administration in children

Abstract

Objective: To describe the time elapsed from onset of pediatric convulsive status epilepticus (SE) to administration of antiepileptic drug (AED).

Methods: This was a prospective observational cohort study performed from June 2011 to June 2013. Pediatric patients (1 month-21 years) with convulsive SE were enrolled. In order to study timing of AED administration during all stages of SE, we restricted our study population to patients who failed 2 or more AED classes or needed continuous infusions to terminate convulsive SE.

Results: We enrolled 81 patients (44 male) with a median age of 3.6 years. The first, second, and third AED doses were administered at a median (p25-p75) time of 28 (6-67) minutes, 40 (20-85) minutes, and 59 (30-120) minutes after SE onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2-3) doses of benzodiazepines were administered before switching to nonbenzodiazepine AEDs. The first and second doses of nonbenzodiazepine AEDs were administered at 69 (40-120) minutes and 120 (75-296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5-15) minutes and 16 (10-40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset).

Conclusions: The time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the prehospital and in-hospital settings.

© 2015 American Academy of Neurology.

Figures

Figure 1. Kaplan-Meier curves representing time from seizure onset to administration of the first AED (green), second AED (blue), and third AED (red)

Time axis is truncated at 100 minutes. As an illustration of the delays in antiepileptic drug (AED) administration, 40 minutes after seizure onset, approximately 60% of patients had received their first AED, approximately 45% of patients had received a second AED, and approximately 25% of patients had received their third AED.

Figure 2. Kaplan-Meier curves representing time to benzodiazepine and non-benzodiazepine antiepileptic drug administration

(A) Time from status epilepticus (SE) onset to benzodiazepine (BZD) administration. Time axis truncated at 100 minutes. Time to administration of first BZD (green) and second BZD (blue). As an illustration of the delays in BZD administration, 20 minutes after seizure onset, approximately 40% of patients had received their first BZD and approximately 25% of patients had received a second BZD. (B) Time from SE onset to non-BZD antiepileptic drug (AED) administration. Time axis truncated at 100 minutes. Time to administration of first non-BZD AED (green) and second non-BZD AED (blue). As an illustration of the delays in non-BZD AED administration, 40 minutes after seizure onset, approximately 25% of patients had received their first non-BZD AED and approximately 10% of patients had received a second non-BZD AED.

Figure 3. Kaplan-Meier curves representing time to antiepileptic drug administration in the prehospital and in-hospital settings

(A) Time from status epilepticus (SE) onset to out-of-hospital antiepileptic drug (AED) administration for patients with out-of-hospital SE onset (times were censored on hospital arrival). Time axis truncated at 100 minutes. Time to administration of first out-of-hospital AED (green) and second out-of-hospital AED (blue). As an illustration of the delays in the prehospital administration of AEDs, 20 minutes after seizure onset, approximately 25% of patients had received their first AED and approximately 10% of patients had received a second AED. (B) Time from hospital management (time 0 was time of SE onset for patients with in-hospital SE onset; time 0 was time of hospital arrival for patients with out-of-hospital SE onset) to in-hospital AED administration. Time axis truncated at 60 minutes. Time to administration of first in-hospital AED (green) and second in-hospital AED (blue). As an illustration of the delays in in-hospital administration of AEDs, 20 minutes after initiation of hospital management, approximately 75% of patients had received their first in-hospital AED and approximately 50% of patients had received a second in-hospital AED.