Treatment of prolonged convulsive seizures in children; a single centre, retrospective, observational study.

OBJECTIVES: To evaluate treatment of children with Prolonged Convulsive Seizures (PCS) at the University Medical Centre Groningen (UMCG).

MATERIAL AND METHODS: PCS were identified from an UMCG database of children with epilepsy aged <18 years who had their first (a)febrile seizure between 2000 and 2010. PCS were included if they lasted ≥10 min and occurred between January 2000 and October 2012 in children aged >1 month. Order, timing, and location of treatment were analysed. Treatment of PCS before and after 2005 was compared with recommendations from a Dutch 2005 treatment guideline for Convulsive Status Epilepticus (CSE) in children aged >1 month.

RESULTS: 269 PCS occurring in 102 children were included (53.9% male, median age 2.8 years; range 0.1-13.7 years). Seventy episodes concerned a first PCS. Most first and subsequent PCS started outside the hospital (78.6% and 82.4%, respectively) and lasted 10-30 min (42.4% and 51.4%, respectively). Cessation occurred after two administrations of any therapy in first (median, range 0-7) and subsequent PCS (median, range 0-10). First treatment choice was rectal diazepam in first (59.6%) and subsequent (43.9%) PCS, but since 2006 a trend towards buccal midazolam was observed in subsequent PCS. Clonazepam was frequently used as second treatment choice in first (43.8%) and subsequent (27.3%) PCS, although not mentioned in the guideline.

CONCLUSION: In our study cohort rectal diazepam is still first choice in the management of PCS despite proven superior efficacy of buccal midazolam. Clonazepam is frequently used although it is not formally recommended in a Dutch guideline.