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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%).

Benay Turan
Ege University Medical Faculty
Turkey

Hasan Tekgul
Ege University Medical Faculty
Turkey

Caner Turan
Ege University Medical Faculty
Turkey

Pınar Yazıcı Ozkaya
Ege University Medical Faculty
Turkey

Seda Kanmaz
Ege University Medical Faculty
Turkey

Erdem Simsek
Ege University Medical Faculty
Turkey

Ali Yurtseven
Ege University Medical Faculty
Turkey

Hepsen Mine Serin
Ege University Medical Faculty
Turkey

Sanem Yılmaz
Ege University Medical Faculty
Turkey

Gul Aktan
Ege University Medical Faculty
Turkey

Sarenur Gokben
Ege University Medical Faculty
Turkey

Bulent Karapınar
Ege University Medical Faculty
Turkey

Eylem Ulas Saz
Ege University Medical Faculty
Turkey

 


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