Preparing an interdisciplinary guidance for the management of generalised paediatric status epilepticus

Abstract

BACKGROUND: A guidance was created to assist family doctors in managing generalized paediatric status epilepticus (GPSE) at Primary HealthCare (PHC) clinics.

AIM: The article aims to discuss the process by which the GPSE guidance was prepared.

OBJECTIVES: The authors intend to provide information on how the literature review was carried out, what clinical threshold was decided as appropriate for the administration of rescue medication, and what treatments may be used in PHC.

METHOD: An initial search and guidance draft was forwarded to a Joint Working Group (JWG) composed of professionals working at PHC and Mater Dei Hospital (MDH). The names of benzodiazepines and their formulations available at PHC clinics were forwarded to the JWG by the clinical Chairperson of Primary HealthCare. A Pubmed search was carried out for the terms “status epilepticus,” “children”, and “prehospital”, filtering for free full text publications, humans, English language, and dating from 1999 to 2019, yielding seventeen results in the English language. Eight were relevant. A second Pubmed search for “diazepam use in paediatric seizures” and “midazolam use in paediatric seizures” yielded fifty-five results, filtering for English and dating from 2010-2019. Two were relevant. Several guidelines and literature were directly referenced. The literature review process and results were summarised and modified into a flowchart.

RESULTS: An interdisciplinary approach was used to decide how GPSE should be treated. Consensus was agreed that if a seizure lasts more than five minutes, benzodiazepines midazolam and diazepam available at PHC clinics, may be used. Intramuscular, intranasal, buccal, or rectal routes are preferred per the child’s weight; and time the duration of seizure activity.

CONCLUSION: GPSE may terminate during the first five minutes of ictal activity. Midazolam and diazepam may be administered by different methods if seizures persist, depending on the clinical scenario.