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Paediatric Infectious Diseases and Neurological Emergencies

C1.3 Convulsive Status Epilepticus – Review and Treatment Update

Dr Alva KF Lam
Associate Consultant,
Department of Paediatrics,
Queen Elizabeth Hospital

Dr Alva KF Lam obtained his medical degree from the University of Hong Kong. After graduation and internship, he joined the Department of Paediatrics, Queen Elizabeth Hospital. Dr Lam completed his paediatric specialist training and obtained Fellowship of Hong Kong College of Paediatricians and Hong Kong Academy of Medicine. He is currently working as Associate Consultant in the Department of Paediatrics, Queen Elizabeth Hospital.

Dr Lam undertook further training in paediatric neurology subsequently. He had the chance to receive overseas training in neurorehabilitation and paediatric neurology in Calgary and Edmonton, Alberta, Canada. He became a board-certified fellow in subspecialty of Paediatric Neurology in 2019.

Dr Lam is a trainer for basic and higher training in General Paediatric Training Programme, Hong Kong College of Paediatricians. He is also appointed as Honorary Assistant Professor in Paediatrics, CUHK.

Convulsive status epilepticus is a medical emergency. It is defined as convulsive seizure lasting for more than 5 minutes or consecutive seizures without recovery of consciousness. International League Against Epilepsy (ILAE) has classified the disease according to four axes – semiology, etiology, electroencephalographic correlate and age. The causes of status epilepticus can be classified into acute symptomatic causes, remote symptomatic causes and progressive encephalopathy. Investigations including laboratory tests, cerebrospinal fluid analysis and neuroimaging should be performed to look for any underlying cause. Continuous video electroencephalography is the gold standard investigation.

Status epilepticus may result in cerebral and systemic complications. Principles of management include seizure termination to prevent complications both from the seizure and pharmacological treatment, to identify underlying etiology and treat accordingly. Treatment of convulsive status epilepticus should be prompt and in a stepwise approach. Benzodiazepine is used as first-line anti-seizure medication. Commonly adopted second-line anti-convulsants include phenytoin, epilim, levetiracetam and phenobarbital. Treatment algorithm, recommended dosage and side effects of respective drugs are discussed. Updated evidence in the choice of different anti-epileptic drugs is also covered.

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