| Abstract [eng] |
Acute tonic-clonic convulsions in children require rapid recognition and prompt drug intervention to prevent progression to status epilepticus, a serious neurological emergency associated with significant morbidity. Despite clear guidelines by the International League Against Epilepsy emphasizing timely benzodiazepine treatment, global adherence remains suboptimal, with notable gaps in dosing accuracy and treatment timing. Objective. This thesis aims to determine which problems exist in the treatment of pediatric status epilepticus and to characterize them. The goals are as follows: 1) Present a literature review of the treatment of children's status epilepticus and identify the global challenges in adhering to international Status epilepticus treatment guidelines and discuss the consequences. 2) Investigate, through an retrospective cross-sectional study, whether the recommendations in hospital discharge summaries align with established algorithms, identifying areas of non-adherence. 3) Propose potential solutions to overcome challenges in adhering to treatment guidelines. Methods. PubMed, Cochrane Library, and Scopus were systematically searched (see appendices for strategy) for English or Lithuanian studies published 2017–2024 on pediatric (1 month–18 years) status epilepticus of any etiology, excluding abstract-only publications, case reports, animal studies, refractory/super-refractory seizures, and medication efficacy/safety comparisons. For this retrospective study data were collected in a single-center retrospective cross-sectional study at Vilnius University Hospital Santaros Klinikos Pediatric Center. Patients aged one month to 18 years diagnosed with epilepsy, status epilepticus, or any acute seizure (International Classification of Diseases-10 codes G40.x, G41.x, R56.x) were included if discharge summaries provided age, weight, diagnoses, treatments, and recommendations, excluding those lacking documented weight for dose/kg calculations. Results. A review of paediatric status epilepticus management demonstrates that rapid, weight-based benzodiazepine administration followed by protocolized escalation remains the cornerstone of therapy. Global studies reveal widespread delays and underdosing in first-line treatment, delayed escalation to second-line treatment and lack of training of caregivers and medical personel. Our retrospective study of 1,540 pediatric discharges revealed that only 57.8% of patients were discharged Pediatric Center with any home rescue medication prescription. Among 890 documented prescriptions only 13.5% deviated from the guidelines. Of the patients diagnosed with status epilepticus, 21.4% were not prescribed any anti-seizure medication. Conclusions. 1) Treatment guidelines mandate benzodiazepine treatment within five minutes of pediatric SE onset and escalation to non-benzodiazepine anti-seizure medication by twenty minutes to minimize loss of efficacy and neuronal injury, yet these timelines are frequently missed globally. Literature shows major knowledge gaps and delays among caregivers and providers, resulting in underdosing and late administration of benzodiazepines and delayed escalation to second-line therapy, prolonging seizures and raising intensive care needs. 2) A retrospective study of 1,540 pediatric discharges at Vilnius University Hospital Santaros Klinikos found that only 57.8% of children left with rescue medication. The rate of noncompliance with established treatment guidelines was calculated to be 13.5%. Of the patients diagnosed with status epilepticus, 21.4% were not prescribed any anti-seizure medication. 3) Potential solutions could be: electronic-medical-record integrated, weight-based decision support, standardized discharge aids, simulation drills, tailored action plans, instructional media, placebo practice, and peer-support networks can eliminate dosing errors and empower timely Status epilepticus recognition and treatment. |
