| Status epilepticus: clinical analysis of a treatment protocol based on midazolam and phenytoin. | |
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MedLine Citation:
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PMID: 15996395 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The efficacy of a combination of midazolam and phenytoin in treating generalized convulsive status epilepticus in children was studied retrospectively. The patient group comprised all patients admitted for generalized convulsive status epilepticus to the pediatric intensive care unit over 7 years. Patients treated according to the protocol were included (N = 122). These patients were treated with the following regimen; each subsequent step was taken if clinical evidence of epileptic activity persisted: midazolam 0.5 mg/kg rectally or 0.1 mg/kg intravenously. After 10 minutes: midazolam 0.1 mg/kg intravenously. After 10 minutes: phenytoin 20 mg/kg intravenously in 20 minutes. After phenytoin load: midazolam 0.2 mg/kg intravenously followed by midazolam 0.1 mg/kg/hour continuously, increased by 0.1 mg/kg/hour every 10 minutes to maximum 1 mg/kg/hour. Phenobarbital 20 mg/kg intravenously or pentobarbital 2 to 5 mg/kg intravenous load, 1 to 2 mg/kg/hour continuously intravenously. Patients who received initial rectal diazepam were included. Patients were categorized according to the cause of generalized convulsive status epilepticus. These categories were then related to the level of antiepileptic therapy needed. Patients' ages ranged from 0.5 to 197.4 months. The cause of generalized convulsive status epilepticus was idiopathic or febrile convulsions in two thirds of cases. Most (89%) patients were managed on midazolam and phenytoin. Generalized convulsive status epilepticus was terminated with midazolam alone in 58 patients, with the addition of phenytoin in 19 patients and with continuous midazolam in 32 patients. Thirteen patients needed additional barbiturates. The relationship between the level of antiepileptic therapy and etiology was not significant. Fifty-two patients needed artificial ventilation. Seven patients died; no deaths were directly attributable to generalized convulsive status epilepticus itself. With the use of the proposed protocol, combining midazolam and phenytoin, 89% of the cases of generalized convulsive status epilepticus could be successfully managed. |
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Authors:
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Judith C D Brevoord; Koen F M Joosten; Willem F M Arts; Roos W van Rooij; Matthijs de Hoog |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Journal of child neurology Volume: 20 ISSN: 0883-0738 ISO Abbreviation: J. Child Neurol. Publication Date: 2005 Jun |
Date Detail:
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Created Date: 2005-07-05 Completed Date: 2005-08-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8606714 Medline TA: J Child Neurol Country: Canada |
Other Details:
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Languages: eng Pagination: 476-81 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Anticonvulsants / therapeutic use* Child Child, Preschool Drug Therapy, Combination Female Humans Hypnotics and Sedatives / administration & dosage, therapeutic use* Infant Infant, Newborn Male Midazolam / administration & dosage, therapeutic use* Phenytoin / therapeutic use* Retrospective Studies Severity of Illness Index Status Epilepticus / drug therapy* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticonvulsants; 0/Hypnotics and Sedatives; 57-41-0/Phenytoin; 59467-70-8/Midazolam |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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