The effectiveness and safety of an institutional treatment protocol for children with convulsive status epilepticus: modified EPSEP

Objective. Evidence-based treatment protocols and guidelines are suggested for the optimal pharmacologic treatment of pediatric convulsive status epilepticus (CSE). To determine the efficacy and safety of a departmental protocol in children with CSE in a cohort between 2016 and 2020. Method. An original institutional treatment regimen called EPSEP (Ege Pediatric Status Epilepticus Protocol) was modified (m-EPSEP) and restructured by adding intravenous valproic acid and levetiracetam in the second step of the protocol based on the evidence-based studies and the new AES2016 guideline. The success rate of terminating CSE for each line of therapy of m-EPSEP was defined. Results: Overall, 300 patients (median age: 5 years, min 1 month-max 17.7 years) were included in the study. The patients were classified according to SE durations, nearly half of the patients (45.6%) were "early SE", 30.0% "Established SE", 13.0% "Refractory SE (RSE)" and 11.3% were "Super refractory CSE". The success rate of each therapy step was 34.6% (100/289) for first-line therapy, 76.7% (145/189) for second-line therapy, and 65.9% (29/44) for third-line therapy. RCSE was defined in 39 of 300 (13.0%) children in the cohort, respectively. While 84.3% of the patients were discharged with at least one ASM, 47 patients were discharged without any ASM. New-diagnosed epilepsy was seen in 44 patients during the study period. Conclusion This retrospective cohort study showed that the m-EPSEP is a safe and effective protocol to terminate CSE in children with a high success rate (87%).
Keywords: Status epilepticus, child, seizure, etiology, treatment protocol