A Comprehensive Assessment of Practical Facets of Srse Treatment, Among Pediatric Intensivists and Neurologists In India

INTRODUCTION: Paediatric SRSE, is one of the most challenging conditions to treat for both intensivists and neurologists. Each step of treatment requires meticulous monitoring and precision and combined effort of both specialities. METHODS: We conducted a validated online survey with 35 questions covering treatment aspects among intensivists and neurologists to assess their knowledge, attitude and practise. Questions encompass several domains including ASM’S, titration of infusions, EEG target parameters and monitoring, TDM levels, immunotherapy. RESULTS:The questionnaire was sent to 250 recipients, yielding 120 responses for analysis. Of the respondents, 55% were neurologists, 45% were intensivists. 15% of them treat more than 10 patients of SRSE annually with common aetiologies being autoimmune encephalitis and FIRES. Only 48.5% maintain a seizure chart since the time of admission. Role of hypertonic saline in treatment remains uncertain, as only 50% of them incorporate its use. Ketamine is the preferred second-line anaesthetic infusion (51%), despite the absence of grade 1 evidence confirming its efficacy. Only 43% assess TDM levels during treatment due to financial and availability constraints. 52% had seizure-based targets, 48% had EEG based targets in treatment of SRSE, with varied degree of percentage suppression. Response to ASM tapering after SRSE resolution exhibited significant diversity. Only 58% have institutional treatment protocol. CONCLUSION:Though SRSE is a devastating condition requiring a formulated consensus guideline, our study yielded a near balanced diversity of opinions among both groups in 80% of questions. This study emphasizes the importance of improving our understanding of SRSE treatment and necessity of guideline formulation.