Wednesday, May 7, 2014

In the March 2014 issue of the journal Epilepsia, Dr. Seinfeld and colleagues representing a multi-center consortium, FEBSTAT Study Team, present results of emergency management of febrile status epilepticus. Treatment of seizures varies by region with no standard emergency treatment protocol. Febrile status epilepticus is often a child’s first seizure, and, therefore, families are rarely educated about emergency treatment.

  • From 2002 to 2010, 199 subjects from age one month to six years were recruited as part of a prospective, multi-center study of febrile status epilepticus, defined as febrile seizure or series of seizures, lasting more than 30 minutes.

  • No standardized treatment protocol was implemented for this study.

  • The investigators included 179 children who received at least one anti-epileptic drug to terminate febrile status epilepticus and more than one drug was required in 140 patients.

  • The median time from seizure onset to the first drug by the emergency medical services or the emergency department was 30 minutes.

  • The mean seizure duration was 81 minutes for patients given medication prior to the emergency department and 95 minutes for those who did not.

  • The median time from the first dose of a drug to the end of the seizure was 38 minutes.

  • The initial dose of lorazepam or diazepam was suboptimal in 19% of the 166 patients.

  • EMS or the emergency department provided respiratory support to 95 or 48% of the study’s subjects.

  • The median seizure duration for respiratory support was 83 minutes, and, for the non-respiratory support group, the duration was 58 minutes.

  • The total seizure duration is composed of two factors: time from seizure onset to anti-epileptic drug initiation and the time from first anti-epileptic drug to seizure termination.

  • Reducing the time from seizure onset to anti-epileptic drug initiation was significantly related to shorter seizure duration.

  • The authors conclude that febrile status epilepticus rarely stops spontaneously and is resistant to medications.

  • A standard pre-hospital treatment protocol should be used nationwide and employed by EMS responders.

Authored by: Joseph I. Sirven MD on 5/2014