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Brigo F, Nardone R, Tezzon F, Trinka E. Nonintravenous midazolam versus intravenous or rectal diazepam for the treatment of early status epilepticus : A systematic review with meta-analysis. Epilepsy Behav 2015 ; 49 : 325-36.

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ILAEInternational League Against Epilepsy2015 status epilepticus SE1

SE is a condition resulting either from the failure of the mechanisms responsible for seizure termi-

nation or from the initiation of mechanisms which lead to abnormally prolonged seizures after time point t1. It is a condition that can have long-term consequences after time point t2, includ-ing neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and

duration of seizures1.

t1 t2

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2

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1 Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus-Report of the ILAE Task Force on

Classification of Status Epilepticus. Epilepsia 2015 ; 56 : 1515-23. 2 Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and

electroencephalographic classification of epileptic seizures. Epilepsia 1981 ; 22 : 489-501. 3 Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on

epilepsy. Epilepsia 1993 ; 34 : 592-6. 4 Wasterlain CG, Chen JW. Definition and classification of status epilepticus. In : Wasterlain CG, Treiman DM, eds. Status Epi-

lepticus, Mechanisms and Management. Cambridge, Massachusetts : the MIT Press, 2006 : 11-6.

5 Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last ? A systematic comparison of seizures recorded in the epi-lepsy monitoring unit. Epilepsia 2006 ; 47 : 1499-503.

6 Dobesberger J, Ristic AJ, Walser G, et al. Duration of focal complex, secondarily generalized tonic-clonic, and primarily gen-eralized tonic-clonic seizures-a video-EEG analysis. Epilepsy Behav 2015 ; 49 : 111-7.

7 Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children last ? Ann Neurol 2001 ; 49 : 659-64. 8 Hesdorffer DC, Benn EK, Bagiella E, et al. Distribution of febrile seizure duration and associations with development. Ann

Neurol 2011 ; 70 : 93-100.

002-007-1-2.indd 5 2017/06/01 21:03:29

6

ILAE1 4 SE 1HHV-6 12

1 semiologywith prominent motor symptoms SECSE CSE

2 etiologysymptomaticcryptogenicSEidiopathic/ge-netic

3 EEG correlatesSE location

4 age1 23 1213

ILAE1 refractory status epilepticusRSE

1 Febrile SESE occurring when the only provocation is a febrile38.0illness

after excluding a direct CNS infection such as meningitis or encephalitis in a previously neurologically healthy child.

2 Acute-symptomaticSE occurring during an acute illness such as brain trauma, CNS infection, cerebrovascular disease, acute diffuse encephalopathyprimary anoxic, and toxic / metabolic insults in a previously neurologically healthy child.

3 Remote-symptomaticSE in a child with a history of a preexisting CNS abnormality in the absence of an identified acute insult.

4 Acute-on-remote-symptomaticSE occurring during an acute neurological insult or febrile illness in a child with a remote symptomatic etiology.

5 Cryptogenic / idiopathic epilepsy-relatedSE occurring in a child with a previous diagnosis of cryptogenic / idiopathic epilepsy, or SE that is the childs second unprovoked seizure, indicating a diagnosis of cryptogenic / idiopathic epilepsy.

6 UnclassifiedSE that cannot be classified into any other group.

Nishiyama I, Ohtsuka Y, Tsuda T, et al. An epidemiological study of children with status epilepticus in Okayama, Japan : incidence, etiologies, and outcomes. Epilepsy Res 2011 ; 96 : 89-95.

1

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72

3 1 first line 1 second line4-6607-122 super-refractory status epilepticusSRSE2011 the Third London-Innsbruck Colloquium on status epilepticus13SRSE 2414

1 Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus-Report of the ILAE Task Force on

Classification of Status Epilepticus. Epilepsia 2015 ; 56 : 1515-23. 2 Nishiyama I, Ohtsuka Y, Tsuda T, et al. An epidemiological study of children with status epilepticus in Okayama, Japan : inci-

dence, etiologies, and outcomes. Epilepsy Res 2011 ; 96 : 89-95. 3 Young GB, Blume WT, Bolton CF, Warren KG. Anesthetic barbiturates in refractory status epilepticus. Can J Neurol Sci

1980 ; 7 : 291-2. 4 Tully I, Draper ES, Lamming CR, et al. Admissions to paediatric intensive care units PICU with refractory convulsive status

epilepticus RCSE: A two-year multi-centre study. Seizure 2015 ; 29 : 153-61. 5 Vooturi S, Jayalakshmi S, Sahu S, Mohandas S. Prognosis and predictors of outcome of refractory generalized convulsive status

epilepticus in adults treated in neurointensive care unit. Clin Neurol Neurosurg 2014 ; 126 : 7-10. 6 Hocker SE, Britton JW, Mandrekar JN, Wijdicks EF, Rabinstein AA. Predictors of outcome in refractory status epilepticus.

JAMA Neurol 2013 ; 70 : 72-7.

7 Kravljanac R, Djuric M, Jankovic B, Pekmezovic T. Etiology, clinical course and response to the treatment of status epilepticus in children : A 16-year single-center experience based on 602 episodes of status epilepticus. Eur J Paediatr Neurol 2015 ; 19 : 584-90.

8 Saz EU, Karapinar B, Ozcetin M, et al. Convulsive status epilepticus in children : etiology, treatment protocol and outcome. Seizure 2011 ; 20 : 115-8.

9 Lambrechtsen FA, Buchhalter JR. Aborted and refractory status epilepticus in children : a comparative analysis. Epilepsia 2008 ; 49 : 615-25.

10 Sahin M, Menache CC, Holmes GL, Riviello JJ Jr. Prolonged treatment for acute symptomatic refractory status epilepti-cus : outcome in children. Neurology 2003 ; 61 : 398-401.

11 Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus : frequency, risk factors, and impact on outcome. Arch Neurol 2002 ; 59 : 205-10.

12 Sahin M, Menache CC, Holmes GL, Riviello JJ. Outcome of severe refractory status epilepticus in children. Epilepsia 2001 ; 42 : 1461-7.

13 Shorvon S. Super-refractory status epilepticus : an approach to therapy in this difficult clinical situation. Epilepsia 2011 ; 52Suppl 8: 53-6.

14 Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus : a critical review of available therapies and a clinical treatment protocol. Brain 2011 ; 134 : 2802-18.

002-007-1-2.indd 7 2017/06/01 21:03:29

8

epidemiology

incidence

SE Nishiyama12 1 151 SE 10 / 41.32 60%2 1 16 10 5 41.0Richmond DeLorenzo

1996 1 30 SE3 10 / 41 10 / 1941 10 / 156 4060 86 015 SE Rochester4 North London5French-speaking Switzerland6 10 / 13.324.11 10 / 50.75135.24

1 Nishiyama I, Ohtsuka Y, Tsuda T, et al. An epidemiological study of children with status epilepticus in Okayama, Japan : inci-

dence, etiologies, and outcomes. Epilepsy Research 2011 ; 96 : 89-95.2 2014 ; 118 : 1336-41.3 DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epiepticus in Ri-

chimond, Virginia. Neurology 1996 ; 46 : 1029-35.4 Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota,

1965-1984. Neurology 1998 ; 50 : 735-41.5 Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC ; NLSTEPSS Collaborative Group. Incidence, cause, and

short-term outcome of convlsive status epilepticus in childhood : prospective population-based study. Lancet 2006 ; 368 : 222-9.6 Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland :EPISTAR.

Neurology 2000 ; 55 : 693-7.

3

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3 9

etiology

SE p.6 1ILAE1993prolonged febrile seizures Acute-symptomatic49.262.7%

16.917.5% / 21 11110 92 2112Shinnar19973DeLorenzo19964 15 52%39% 21% 10% 34% 24% 22% 15% 13% 13% 50% 38% 42%16 59 54%60 30%

SENorth London5 Rochester6 23.231.8% 49.262.7% HHV-6 / HHV-7 34.3%7 27.1%59915%120119.1%

North London 4%Richmond 3% A H1N18Glaser A H1N19 SE Kenya 9%102006

North London 7% SE .secondary brain injury

008-016-3-4.indd 9 2017/06/01 21:03:58

10

11PICU18.4% SE 75%nonconvulsive status epilepticusNCSE12. CSE NCSE 1 NCSE13.

3050%14-17RSEremote symptomatic15-19SRSEacute encephalitis with refractory, repetitive partial seizuresAER-RPS20 new-onset refractory status epilepticusNORSE21 febrile infectionrelated epilepsy syndromeFIRES22devastating epileptic encephalopathy in school-aged childrenDESC23 720%24-27RSE22%28 41 1639% SRSE27SRSE 16100%24-27 3060% encephalitispresumed encephalitis 6070%25, 27

1 Nishiyama I, Ohtsuka Y, Tsuda T, et al. An epidemiological study of children with status epilepticus in Okayama, Japan : inci-

dence, etiologies, and outcomes. Epilepsy Research 2011 ; 96 : 89-95.2 2014 ; 118 : 1336-41.3 Shinnar S, Pellock JM, Mosh SL, et al. In whom does status epilepticus occur : age-related differences in children. Epilepsia

1997 ; 38 : 907-14.4 DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epiepticus in Ri-

chimond, Virginia. Neurology 1996 ; 46 : 1029-35.5 Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC ; NLSTEPSS Collaborative Group. Incidence, cause, and

short-term outcome of convlsive status epilepticus in childhood : prospective population-based study. Lancet 2006 ; 368 : 222-9.6 Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota,

1965-1984. Neurology 1998 ; 50 : 735-41.7 Epstein LG, Shinnar S, Hesdorffer DC, et al. Human herpesvirus 6 and 7 in febrile status epilepticus : The FEBSTS study. Epi-

lepsia 2012 ; 53 : 1481-8.

8 Kawashima H, Morichi S, Okumura A, Nakagawa S, Morishima T ; collaborating study group on influenza-associated enceph-alopathy in Japan. National survey of pandemic influenza AH1N1 2009-associated encephalopathy in Japanese children. J Med Virol 2012 ; 84 : 1151-6.

9 Glaser CA, Winter K, DuBray K, et al. A population-based study of neurologic manifestations of severe influenza AH1N1 pdm09 in California. Clin Infect Dis 2012 ; 55 : 514-20.

10 Sadarangani M, Seaton CG, Scott A, et al. Incidence and outcome of convulsive status epilepticus in Kenyan children : a cohort study. Lancet Neurol 2008 ; 7 : 145-50.

11 Arndt DH, Goodkin HP, Giza CC. Early posttraumatic seizures in the pediatric population. J Child Neurol 2016 ; 31 : 46-56.12 Arndt DH, Lerner JT, Matsumoto JH, et al. Subclinical early posttraumatic seizures detected by continuous EEG monitoring in

a consecutive pediatric cohort. Epilepsia 2013 ; 54 : 1780-8.13 Hasbani DM, Topjian AA, Friess SH, et al. Nonconvulsive electrographic seizures are common in children with abusive head

trauma. Pediatr Crit Care Med 2013 ; 14 : 709-15.14 Kravljanac R, Djuric M, Jankovic B, Pekmezovic T. Etiology, clinical course and response to the treatment of status epilepticus

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3 11

in children : A 16-year single-center experience based on 602 episodes of status epilepticus. Eur J Paediatr Neurol

2015 ; 19 : 584-90.15 Saz EU, Karapinar B, Ozcetin M, et al. Convulsive status epilepticus in children : etiology, treatment protocol and outcome.

Seizure 2011 ; 20 : 115-8.


17 Koul R, Chacko A, Javed H, Al Riyami K. Eight-year study of childhood status epilepticus : midazolam infusion in manage-ment and outcome. J Child Neurol 2002 ; 17 : 908-10.

18 Tully I, Draper ES, Lamming CR, et al. Admissions to paediatric intensive care unit PICU with refractory convulsive status epilepticus RCSE: A two-year multi-centre study. Seizure 2015 ; 29 : 153-61.


20 Sakuma H. Acute encephalitis with refractory, repetitive partial seizures. Brain Dev 2009 ; 31 : 510-4.21 Wilder-Smith EP, Lim EC, Teoh HL, et al. The NORSE new-onset refractory status epilepticus syndrome : defining a dis-

ease entity. Ann Acad Med Singapore 2005 ; 34 : 417-20.22 Kramer U, Chi CS, Lin KL, et al. Febrile infection-related epilepsy syndrome FIRES: pathogenesis, treatment, and out-

come : a multicenter study on 77 children. Epilepsia 2011 ; 52 : 1956-65.23 Mikaeloff Y, Jambaqu I, Hertz-Pannier L, et al. Devastating epileptic encephalopathy in school-aged children DESC: a

pseudo encephalitis. Epilepsy Res 2006 ; 69 : 67-79.24 Kravljanac R, Djuric M, Jankovic B, Pekmezovic T. Etiology, clinical course and response to the treatment of status epilepticus

in children : A 16-year single-center experience based on 602 episodes of status epilepticus. Eur J Paediatr Neurol 2015 ; 19 : 584-90.

25 Tian L, Li Y, Xue X, et al. Super-refractory status epilepticus in West China. Acta Neurol Scand 2015 ; 132 : 1-6.26 Pugin D, Foreman B, De Marchis GM, et al. Is pentobarbital safe and efficacious in the treatment of super-refractory status epi-

lepticus : a cohort study. Crit Care 2014 ; 18 : R103.27 Jayalakshmi S, Ruikar D, Vooturi S, et al. Determinants and predictors of outcome in super refractory status epilepticus--a de-

veloping country perspective. Epilepsy Res 2014 ; 108 : 1609-17.28 Kantanen AM, Reinikainen M, Parviainen I, et al. Incidence and mortality of super-refractory status epilepticus in adults. Epi-

lepsy Behav 2015 ; 49 : 131-4.

mortality

Aicardi11970 23928.0% 26.4% 25.3% 24.7% 11% 1

Shinnar22001 10 180SE30 30 0Metsranta32004 5 42.5 16 186279 0

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20% RSE 030%6-11SRSE 1050%12-151 3658%13, 15

1 Aicardi J, Chevrie JJ. Convulsive status epilepticus in infants and children. A study of 239 cases. Epilepsia 1970 ; 11 : 187-97.2 Shinnar S, Pellock JM, Berg AT, et al. Short-term outcomes of children with febrile status epilepticus. Epilepsia 2001 ; 42 : 47-

53.

3 Metsranta P, Koivikko M, Peltola J, Eriksson K. Outcome after prolonged convulsive seizures in 186 children : low morbidity, no mortlity. Dev Med Child Neurol 2004 ; 46 : 4-8.

4 Raspall-Chaure M, Chin RFM, Neville BG, Scott RC. Outcome of paediatric convulsive status epilepticus : a systematic re-view. Lancet Neurol 2006 ; 5 : 76979.

5 DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epiepticus in Ri-chimond, Virginia. Neurology 1996 ; 46 : 1029-35.

6 Tully I, Draper ES, Lamming CR, et al. Admissions to paediatric intensive care units PICU with refractory convulsive status epilepticus RCSE: A two-year multi-centre study. Seizure 2015 ; 29 : 153-61.

7 Kravljanac R, Djuric M, Jankovic B, Pekmezovic T. Etiology, clinical course and response to the treatment of status epilepticus in children : A 16-year single-center experience based on 602 episodes of status epilepticus. Eur J Paediatr Neurol


Seizure 2011 ; 20 : 115-8.





lepticus : a cohort study. Crit Care 2014 ; 18 : R103.14 Jayalakshmi S, Ruikar D, Vooturi S, et al. Determinants and predictors of outcome in super refractory status epilepticus - a de-


lepsy Behav 2015 ; 49 : 131-4.

neurological sequelae

SE

Aicardi1 37% SE 57% 1Raspall-Chaure2 1374% 50%SE 15%

008-016-3-4.indd 12 2017/06/01 21:03:58

3 13

febrile status epilepticusFSE Scott32014 review 0 FEBSTAT4, 5London6, 7FSEScottRSE 570%8-13

SRSE 2672%14-17

1 Aicardi J, Chevrie JJ. Convulsive status epilepticus in infants and children. A study of 239 cases. Epilepsia 1970 ; 11 : 187-97.2 Raspall-Chaure M, Chin RF, Neville BG, Scott RC. Outcome of paediatric convulsive status epilepticus : a systematic review.

Lancet Neurol 2006 ; 5 : 769-79.

3 Scott RC. Consequences of febrile seizures in childhood. Curr Opin Pediat 2014 ; 26 : 662-7.4 Shinnar S, Bello JA, Chan S, et al. MRI abnormalities following febrile status epilepticus in children. The FEBSTAT study.

Neurology 2012 ; 79 : 871-7.

5 Lewis DV, Shinnar S, Hesdorffer DC, et al. Hippocampal sclerosis after febrile status epilepticus : The FEBSTAT study. Ann Neurol 2014 ; 75 : 178-85.

6 Scott RC, Gadian DG, King MD, et al. Magnetic resonance imaging findings within 5 days of status epilepticus in childhood. Brain 2002 ; 125 : 1951-9.

7 Scott RC, King MD, Gadian DG, Neville BG, Connelly A. Hippocampal abnormalities after prolonged febrile convulsion : a longitudinal MRI study. Brain 2003 ; 126 : 2551-7.

8 Tully I, Draper ES, Lamming CR, et al. Admissions to paediatric intensive care units PICU with refractory convulsive status epilepticus RCSE: A two-year multi-centre study. Seizure 2015 ; 29 : 153-61.

9 Kravljanac R, Djuric M, Jankovic B, Pekmezovic T. Etiology, clinical course and response to the treatment of status epilepticus in children : A 16-year single-center experience based on 602 episodes of status epilepticus. Eur J Paediatr Neurol


Seizure 2011 ; 20 : 115-8.





lepticus : a cohort study. Crit Care 2014 ; 18 : R103.16 Jayalakshmi S, Ruikar D, Vooturi S, et al. Determinants and predictors of outcome in super refractory status epilepticus - a de-


lepsy Behav 2015 ; 49 : 131-4.

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14

2010GL GL 1 GL GL

1 Glauser2016American Epilepsy Society stabilizationinitial therapy 520second therapy20 40third therapy40 60 4 phase

initial therapy phaseLZPDZPMDLlevel APBlevel ADZPMDLlevel BPBDZPMDLlevel B class 1 LZPDZPlevel AMDL DZPlevel BCSE LZPDZPMDLlevel B

second therapy phasefosPHTLEVlevel UVPAlevel B PBlevel BPHT fosPHT fosPHT

third therapy phase second therapy phaseMDLCSE phase

4

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154

Brophy2012Brophyrefractory SE young children

2 NICENational Institute for Health and Care ExcellenceCG137 2016 updateprolonged or repeated seizures and convulsive status epilepticus 2012 2011Appendix F

community1st step5132nd step5 CSEMDLCSEMDL DZP3rd step15 LZPLZP DZP

MDL 24th step25PHT PB5th step45MDL CSE

3 Shah2014 CSE GRADE methodologymoderatestrong DZPMDLlowstrongMDL DZPvery lowweak

Shah MI, Macias CG, Dayan PS, et al. An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using

GRADE Methodology. Prehosp Emerg Care 2014 ; 18Suppl 1: 15-24.Brophy GM, Bell R, Claassen J, et al. ; Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines

for the evaluation and management of status epilepticus. Neurocrit Care 2012 ; 17 : 3-23.USAGlauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline : Treatment of Convulsive Status Epilepticus in Children and

Adults : Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016 ; 16 : 48-61.USANICE The epilepsies : the diagnosis and management. Published : 11 January 2012 last updated February 2016.https://www.

nice.org.uk/guidance/cg137UKCapovilla G, Beccaria F, Beghi E, Minicucci F, Sartori S, Vecchi M. Treatment of convulsive status epilepticus in childhood : rec-

ommendations of the Italian League Against Epilepsy. Epilepsia 2013 ; 54Suppl 7: 23-34.ItalyFriedman J, Canadian Paediatric Society, Acute Care Committee. Emergency management of the paediatric patient with general-

ized convulsive status epilepticus. Paediatr Child Health 2011 ; 16 : 91-7.CanadaNSW Guideline : Infants and Children-Acute Management of Seizures. 3rd Edition, Issue date : February-2016.New South

Wales, Australia

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16

Glauser 2016

USNSW 2016

AustraliaNICE 2016UK

Shah 2014US

Capovilla 2013Italy

Brophy 2012US

Friedman 2011Canada

prehospitalpr DZP

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buccal/in/im MDL0.2 mg/kg

prehospitalbuccal MDL

0.5 mg/kgim MDL

not specifiedpr DZP

0.5 mg/kg

1st line treatment prehospitalbuccal/pr LZP

0.1 mg/kgbuccal MDL

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0.5 mg/kg

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5-20minim MDL

5 mg for 13-40 kg10 mg for40 kg

iv LZP0.1 mg/kgiv DZP

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15 mg/kgpr DZP

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not specified

5-15miniv MDL

0.15 mg/kgiv DZP

0.25 mg/kg

no IV accessbuccal/in MDL

0.3 mg/kgim MDL

0.15 mg/kg

2nd step5-15min

buccal MDL0.5 mg/kgiv LZP

0.1 mg/kg

3rd step15-25min

iv LZP0.1 mg/kg

2nd dose of benzodiazepine IV access presentiv MDL

0.1 mg/kgiv LZP

0.1 mg/kgiv DZP

0.1 mg/kg

no IV access presentbuccal/in/im MDL

0.2 mg/kg

initial CSEIV access presentiv LZP

0.1 mg/kgiv DZP

0.5 mg/kgiv MDL

0.2 mg/kg

no venous accessbuccal MDL

0.5 mg/kgim MDL

0.2 mg/kgbuccal LZP

0.1 mg/kg

emergent initial therapyLZP

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0.2 mg/kgpr DZP

0.5 mg/kg 2-5y0.3 mg/kg 6-11y0.2 mg/kg12y

in hospitalrapid IV accessiv LZP

0.1 mg/kgiv MDL

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0.3 mg/kg

no IV accessbuccal/pr LZP

0.1 mg/kgbuccal MDL

0.5 mg/kgin/im MDL

0.2 mg/kgpr DZP

0.5 mg/kg

second therapy phase

20-40minfosPHT

20 mgPE/kgVPA

40 mg/kgLEV

60 mg/kgPB

15 mg/kg

15-40minPHT

20 mg/kgLEV

20 mg/kgPB

20 mg/kg

4th step25-45min

PHT20 mg/kgPB

20 mg/kg

definite CSEPHT

18-20 mg/kgPB

15-20 mg/kgVPA

30-45 mg/kg

urgent control therapyfosPHT/PHT

20 mg/kgVPA

20-40 mg/kgLEV

20-60 mg/kg

2nd line treatmentiv access presentfosPHT

20 mgPE/kgPHT

20 mg/kgPB

20 mg/kg

no IV accessim fosPHT

20 mgPE/kgpr paraldehydeio PHT

20 mg/kg

third therapy phase

40-60 minthiopentalMDLpentobarbitalpropofol

anesthetic dose

40minthiopental

2-5 mg/kg

5th step45min

thiopental4 mg/kg

refractory CSEthiopental

3 mg/kg 1-15 mg/kg/hrpropofol

1-5 mg/kg 5 mg/kg/hrMDL

0.2 mg/kg cease0.06 mg/kg no response 0.2 mg/kg 0.5-1 mg/kg/hriv VPA

30-45 mg/kgiv high dose PBiv LEV/oral TPM/isoflurane/ lidocaine/ketamine/lacosamide

refractory therapyci MDL

0.2 mg/kg 0.05-2 mg/kg/hrpentobarbital

5-15 mg/kg 0.5-5 mg/kg/hrthiopental

2-7 mg/kg 0.5-5 mg/kg/hr

refractorySEci MDL

0.15 mg/kg 2g/kg/minmax 24g/kg/minpentobarbital

10 mg/kg 0.5-1 mg/kg/hrthiopental

2-4 mg/kg 2-4 mg/kg/hr

im : intramuscularin : intranasaliv : intravenouspr : per rectalio : intraosceusci : continuous infusionPE : phenytoin equivalents.

1

008-016-3-4.indd 16 2017/06/01 21:03:59

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017-_.indd 17 2017/06/01 21:04:23

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SE 30 30 51, 2 Shinnar3Hesdorffer4

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39.45641.1SE 30

CQ1

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018-023-3_CQ1.indd 18 2017/06/01 21:05:11

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SE

DZPPBMDL1, 2, 7-9DZP1, 910paramedic

150350 ng/mL 308 2 2411

10.8 30 39 60 SE12-15SE

DZP 72.7% 11.6 mg/kg16 30

018-023-3_CQ1.indd 19 2017/06/01 21:05:11

20

48 peak level1 47 mg/kg

2016 28 2SE

018-023-3_CQ1.indd 20 2017/06/01 21:05:11

CQ1 21

1 1970 DZP 1997 Diastat 2acute repetitive seizuresARS

Diastat 25 0.5 mg/kg611 0.3 mg/kg12 0.2 mg/kg 20 mg/1 55 Diastat 15 mg15 200g/L17 ARS Kriel18 the North American

Diastat study groupDiastat6865 31% 59%somnolenceKriel19 41428 DZP85%Chiang20 Taiwan 24 103Stesolid rectal tube87.3% 102 MDLBuccolam21-2324Lee24 Buccolam

DZPCOI ViroPharma2.5 mg1 3 65 mg57.5 mg1010 mg18 3 18 110MDL25

018-023-3_CQ1.indd 21 2017/06/01 21:05:12

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3 CQ3

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p.81PubMed160Web44

1 Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline : Treatment of Convulsive Status Epilepticus in Children and

Adults : Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016 ; 16 : 48-61.2 NICE The epilepsies : the diagnosis and management. Published : 11 January 2012 last updated February 2016. https://www.nice.org.uk/guidance/cg1373 Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children last ? Ann Neurol 2001 ; 49 : 659-64.4

4 Hesdorffer DC, Benn EK, Bagiella E, et al. Distribution of febrile seizure duration and associations with development. Ann Neurol 2011 ; 70 : 93-100.4

5 28 28 12 20 http://www.fdma.go.jp/neuter/topics/houdou/h28/12/281220_houdou_2.pdf6 2015 ; 119 : 1226-32.4

7 Shah MI, Macias CG, Dayan PS, et al. An Evidence-based Guideline for Pediatric Prehospital Seizure Management Using GRADE Methodology. Prehosp Emerg Care 2014 ; 18Suppl 1: 15-24.1

8 NSW Guideline : Infants and Children-Acute Management of Seizures. 3rd Edition, Issue date : February-2016.9 Friedman J, Canadian Paediatric Society, Acute Care Committee. Emergency management of the paediatric patient with gener-

alized convulsive status epilepticus. Paediatr Child Health 2011 ; 16 : 91-7.10 Appleton R, Choonara I, Martland T, Phillips B, Scott R, Whitehouse W. The treatment of convulsive status epilepticus in chil-

dren. Arch Dis Child 2000 ; 83 : 415-9.11 Minagawa K, Miura H, Mizuno S, Shirai H. Pharmacokinetics of rectal diazepam in the prevention of febrile convulsions. Brain

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CQ1 23

drate. Pediatr Neurol 2002 ; 27 : 388-91.416 Phenobarbital1979 ; 32 : 671-81.4

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adolescent : a randomized trial. Lancet 1999 ; 353 : 623-6.2

018-023-3_CQ1.indd 23 2017/06/01 21:05:13

24

1.15

2.

1. SE A

0.15 mg/kg 1mg/ 0.10.3 mg/kg 0.6 mg/kg 0.30.5 mg/kg

1-7DZPLZPMDL1, 2, 4, 61-62, 6, 7

SE DZP1990

MDL SE2014

MDL DZPDZPMDLLZP

MDLMDL

CQ2

A

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024-028-4_CQ2.indd 24 2017/06/01 21:05:44

CQ2 25

10 mg/10 mLDZP 30 DZPMDLMDL DZP

5 1

DZP0.30.5 mg/kgMDL0.10.3 mg/kg5 2DZP Capovilla4Italy 0.5 mg/kg 0.10.3 mg/kg DZP 12ICU

HCU 3

SE DZP8-151 0.20.3 mg/kg Appleton8 64.7%Thakker14 65.2% 70100%140 Chamberlain15

3 18 ERLZP 35.0% 16.4% 9.3% 26.4% 72.1% Lahat9 26 24 510 23MDL Appleton8 20.6%Chamberlain15 16%

024-028-4_CQ2.indd 25 2017/06/01 21:05:45

26

45.7%Tonekaboni13 21.7%0%

SEMDLMDL1, 2, 4, 61 0.1 mg/kg 0.2 mg/kg 2

Papavasiliou16 1155 76MDL 0.1 mg/kg 5 53 89% 0.170.09 mg/kg5 91% 13.1% 3%DZPDZP17 82 71% 57%

0.173 mg/kg 45.9%MDL 35 85.7% 50%MDL 3Yoshikawa18 1016 8140.10.3 mg/kg 1 1Hayashi19

MDL 70 74.3% 52 17.3%

60 mg/kg 0.5 g/kg 25 g 0.02 mg/kg 1 mg6

024-028-4_CQ2.indd 26 2017/06/01 21:05:45

CQ2 27

p.82 PubMed 310Web260

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hood : recommendations of the Italian League Against Epilepsy. Epilepsia 2013 ; 54Supple.7: 23-34.1 5 Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline : Treatment of Convulsive Status Epilepticus in Children and

Adults : Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016 ; 16 : 48-61.1 6 NSW Guideline Infants and Children - Acute Management of Seizures. 3rd Edition, Issue date : February-2016. 7 NICE The epilepsies : the diagnosis and management. Published : 11 January 2012 last updated February 2016. https://www.nice.org.uk/guidance/cg137 8 Appleton R, Sweeney A, Choonara I, Robson J, Molyneux E. Lorazepam versus diazepam in the acute treatment of epileptic

seizures and status epilepticus. Dev Med Child Neurol 1995 ; 37 : 682-8.2 9 Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for

treating febrile seizures in children : prospective randomised study. BMJ 2000 ; 321 : 83-6.210 Mahmoudian T, Zadeh MM. Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in chil-

dren. Epilepsy Behav 2004 ; 5 : 253-5.211 Talukdar B, Chakrabarty B. Efficacy of buccal midazolam compared to intravenous diazepam in controlling convulsion in chil-

dren : a randomized controlled trial. Brain Dev 2009 ; 31 : 744-9.212 Javadzadeh M, Sheibani K, Hashemieh M, Saneifard H. Intranasal midazolam compared with intravenous diazepam in patei-

ents suffering from acute seizure : a randomized clinical trial. Iran J Pediatr 2012 ; 22 : 1-8.213 Tonekaboni SH, Shamsabadi FM, Anvari SS, Mazrooei A, Ghofrani M. A comparison of buccal midazolam and intravenous

diazepam for the acute treatment of seizures in children. Iran J Pediatr 2012 ; 22 : 303-8.214 Thakker A, Shanbag P. A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute child-

hood seizures. J Neurol 2013 ; 260 : 470-4.215 Chamberlain JM, Okada P, Holsti M, et al. ; Pediatric Emergency Care Applied Research Network PECARN. Lorazepam vs

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LZPLZPDZPCochrane Database of Systematic Reviews20LZP 3 Appleton8 1Chamberlain15LZPDZP72.9%72.1%LZP5LZP DZP SEMDL LZP 3 AMDL

024-028-4_CQ2.indd 27 2017/06/01 21:05:46

28

tus epilepticus in children with pharmacoresistant epilepsy. Epilepsy Behav 2009 ; 14 : 661-4.417 8 midazolam

2003 ; 35 : 484-90.418 Yoshikawa H, Yamazaki S, Abe T, Oda Y. Midazolam as a first-line agent for status epilepticus in children. Brain Dev

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of Systematic Reviews 2014, Issue 9.1

024-028-4_CQ2.indd 28 2017/06/01 21:05:46

CQ3 29

1.

10 mg/2 mL

10 mg/10 mL

0.30.5 mg/kg

MDL0.20.5 mg/kg0.2 mg/kg0.20.5 mg/kgDZP0.30.5 mg/kg1-8MDL DZPCQ1BrigoMDL DZP

CQ3

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029-032-5_CQ3.indd 29 2017/06/01 21:06:10

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8 022%

MDL 48 690.2 mg/kg6493%9 20200.2 mg/kg1995% 5 3.56010

BrigoMDLDZP1966 2015 198MDL DZPMDLDZPMDLDZP423MDLDZPBrigo11MDL12, 13

DZPDZP14

029-032-5_CQ3.indd 30 2017/06/01 21:06:11

CQ3 31

8, 15Chiang DZP10 mg/2 mL DZP10 mg/2.5 mLStesolid rectal tube16

DZP 3017CQ1

CQ1 . SE


1 Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline : Treatment of Convulsive Status Epilepticus in Children and

Adults : Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016 ; 16 : 48-61.1 2 NSW Guideline Infants and Children - Acute Management of Seizures. 3rd Edition, Issue date : February-2016. 3 NICE The epilepsies : the diagnosis and management. Published : 11 January 2012 last updated February 2016. https://www.nice.org.uk/guidance/cg137 4 Mishra D, Sharma S, Sankhyan N, et al. ; Multi-disciplinary Group on Management of Status Epilepticus in Children in India.

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32

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hood : recommendations of the Italian League Against Epilepsy. Epilepsia 2013 ; 54Suppl 7: 23-34.1 7 Friedman J, Canadian Paediatric Society, Acute Care Committee. Emergency management of the paediatric patient with gener-

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029-032-5_CQ3.indd 32 2017/06/01 21:06:11

CQ4 33

1.

1 2 3 4

2015

1 1 Glasgow Coma Scale15151, 2

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033-036-6_CQ4.indd 33 2017/06/01 21:06:40

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/ 11769 24 1420%3

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033-036-6_CQ4.indd 34 2017/06/01 21:06:40

CQ4 35

CQ11CQ13


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13 Sadarangani M, Seaton C, Scotta JA, et al. Incidence and outcome of convulsive status epilepticus in Kenyan children : a cohort study. Lancet Neurol 2008 ; 7 : 145-50.3

033-036-6_CQ4.indd 36 2017/06/01 21:06:41

CQ5 37

1.

2.

SE1Chamberlain2 SEDZP140LZP133 76.5%79.4% 4 38.6%39.2% SE SE SE SESELahat3MDL2126 DZP2326 88.5%92.3% 60 1

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037-039-7_CQ5.indd 37 2017/06/01 21:06:56

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037-039-7_CQ5.indd 38 2017/06/01 21:06:56

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MDL3 DZPMDL

MDLCQ8MDL9MDL


1 Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care

2012 ; 17 : 3-23. 2 Chamberlain JM, Okada P, Holsti M, et al. ; Pediatric Emergency Care Applied Research Network PECARN. Lorazepam vs

diazepam for pediatric status epilepticus : a randomized clinical trial. JAMA 2014 ; 311 : 23-30.3 3 Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for

treating febrile seizures in children : prospective randomized study. BMJ 2000 ; 321 : 83-6.3 4 8 midazolam

2003 ; 35 : 484-90.4 5 Yoshikawa H, Yamazaki S, Abe T, Oda Y. Midazolam as a first-line agent for status epilepticus in children. Brain Dev

2000 ; 22 : 239-42.4 6 Hayashi K, Osawa M, Aihara M, et al. ; Research Committee on Clinical Evidence of Medical Treatment for Status Epilepticus


4 7 Morrison G, Gibbons E, Whitehouse WP. High-dose midazolam therapy for refractory status epilepticus in children. Intensive

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for refractory nonconvulsive status epilepticus. Neurology 2001 ; 57 : 1036-42.4 9 Sreenath TG, Gupta P, Sharma KK, Krishnamurthy S. Lorazepam versus diazepam-phenytoin combination in the treatment of

convulsive status epilepticus in children : a randomized controlled trial. Eur J Paediatr Neurol 2010 ; 14 : 162-8.2

037-039-7_CQ5.indd 39 2017/06/07 8:59:14

40

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040-044-8_CQ6.indd 40 2017/06/01 21:07:21

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040-044-8_CQ6.indd 41 2017/06/01 21:07:21

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040-044-8_CQ6.indd 42 2017/06/01 21:07:21

CQ6 43

VPALEV1 VPA PB 2VPA 90%27 / 30 PB 77%23 / 3018Alvarez13 187 PHT 74.6%44 / 59VPA 58.6%41 / 70LEV 51.7%30 / 58Kravljanac5 602 LEV 63.6%7 / 11Zelano19 LEV 118 4494%Aiguabella20 40 LEV LEVLEV LEV 1 2 24 VPALEV

LEVLEV41 20 mg/kg 1 2 50 kg

PHT / fosPHT PBPHT / fosPHTPB

17 fosPHT 64.7%11 / 17fosPHT PHT / fosPHT

040-044-8_CQ6.indd 43 2017/06/01 21:07:21

44


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040-044-8_CQ6.indd 44 2017/06/01 21:07:22

CQ7 45

ICU

1. ICU

2.ICU

3. 1ICU

ICU

10 147 153 32% 13.6%13% 13% 5%10%1CQ142-6 ICU

ICU7-9

CQ7

A

B

B

045-046-9_CQ7.indd 45 2017/06/01 21:07:56

46

ICU3, 10CQ14 14 1 ICU


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045-046-9_CQ7.indd 46 2017/06/01 21:07:57

CQ8 47

1.

2.

refractory status epilepticusRSEICU

1-3

0.2mg/kg0.050.5mg/kg/ 510 0.05mg/kg 2mg/kg/

2448breakthroughseizure0.10.2mg/kg breakthrough seizure 50%

1-3

1mg/kg/ 27mg/kg 3mg/kg 2 2

1mg/kg/ 21mg/kg/15mg/kg/0.55mg/kg/

CQ8

A

B

047-052-10_CQ8.indd 47 2017/06/01 21:08:36

48

breakthrough seizure 12mg/kg 12 0.51mg/kg/

12484, 5

45mg/kg1mg/kg/ 10mg/kg/

1248

1 2

15g/kg/ 20g/kg/ 15g/kg/ 20g/kg/

refractory status epilepticusRSE6RSE ICU1-3, 7-112, 7-91, 3, 11 RSE RSE

RSE12, 135, 14, 15 3 CQ

047-052-10_CQ8.indd 48 2017/06/01 21:08:36

CQ8 49

1-34, 5 2448 12481-3

0.2 mg/kg 0.050.5 mg/kg/510 0.05 mg/kg 2 mg/kg/2448breakthrough seizure 0.10.2 mg/kg breakthrough seizure 1.442.9 mg/kg/ 50%16, 17 RSE 0.2 mg/kg/ 0.4 mg/kg/ 0.4

mg/kg/ 2.9 mg/kg/ 64% 15% 62% 40% 59% 48% 32% 53%16ICU

3 mg/kg 2 2 115 mg/kg/2 1 mg/kg/1, 3 1 mg/kg/ 27 mg/kg 0.55 mg/kg/breakthrough seizure 12 mg/kg12 0.51 mg/kg/2 1248

047-052-10_CQ8.indd 49 2017/06/01 21:08:36

50

refractory status epilepticusRSE 2 RSE 6 119 RSE 0.22 0.110.120.48mg/kg/ 86%breakthrough seizure 57% 40 1040%20

Claassen RSE 54 33 106 20% 8%breakthrough seizure 51% 12% 63% 43% 46% 48% 30% 77% 100% 4% 0% 96%12

Wilkes 76% 0.168 mg/kg/ 0.642 mg/kg/65%13

1.5 18 RSE 154 RSE 10 85 100% 45 mg/kg110 mg/kg/

047-052-10_CQ8.indd 50 2017/06/01 21:08:37

CQ8 51

200521

SE0.10.5 mg/kg/22-24 RSE Fernandez16Singhi2050%RSENagase5breakthrough seizure CQ RSE SESERSE ICU /

breakthrough seizure5, 14, 15145

p.88 PubMed 47Web77

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Consensus guidelines on management of childhood convulsive status epilepticus. Indian Pediatr 2014 ; 51 : 975-90.

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21 2006 ; 38 : 236-43.22 8 midazolam

2003 ; 35 : 484-90.423 Yoshikawa H, Yamazaki S, Abe T, Oda Y. Midazolam as a first-line agent for status epilepticus in children. Brain Dev

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4

047-052-10_CQ8.indd 52 2017/06/01 21:08:38

CQ9 53

1.

super-refractory status epilepticusSRSE 21, 22initial control failure breakthrough seizure withdrawal seizureintolerable side effect CQ10

CQ9

C1

053-058-11_CQ9.indd 53 2017/06/01 21:09:03

54

1 NMDA

SRSE 1SRSESRSE SRSE2 171482%2 2 238 10 84 67 91%5SRSErefractory status epilepticusRSE0.067.5 mg/kg/ 906 48 107, 8

0.59%6,620 14

2 2 11 7 272 41%9-11 7 7 75 3 29 112

053-058-11_CQ9.indd 54 2017/06/01 21:09:03

CQ9 55

SRSE2 57%40 / 7013-22 10%1 / 1023, 24 0%0 / 225 46%17 / 3526-3325%3 / 1234 100%5 / 535 SRSE 100%3 / 33650%5 / 1037 1

febrile infection-related epilepsy syndromeFIRES SRSE2 215%12 SRSE 138 GABAB 139

SRSE2 36332 213218 NMDA SRSE 140

2 SRSE 41 1412 12 FIRES2 1 7 10 90%415 12

053-058-11_CQ9.indd 55 2017/06/01 21:09:04

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053-058-11_CQ9.indd 56 2017/06/01 21:09:05

CQ9 57

742-4612 242, 46


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43 Fung EL, Chang SK, Yam KK, Yau PY. Ketogenic Diet as a Therapeutic Option in Super-refractory Status Epilepticus. Pediatr Neonatol 2015 ; 56 : 429-31.4

44 Cobo NH, Sankar R, Murata KK, Sewak SL, Kezele MA, Matsumoto JH. The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus : challenges in implementation in the pediatric and neonatal intensive care units. J

Child Neurol 2015 ; 30 : 259-66.445 Singh RK, Joshi SM, Potter DM, Leber SM, Carlson MD, Shellhaas RA. Cognitive outcomes in febrile infection-related epilep-

sy syndrome treated with the ketogenic diet. Pediatrics 2014 ; 134 : e1431-5.446 Strzelczyk A, Reif PS, Bauer S, et al. Intravenous initiation and maintenance of ketogenic diet : proof of concept in super-re-

fractory status epilepticus. Seizure 2013 ; 22 : 581-3.4

053-058-11_CQ9.indd 58 2017/06/01 21:09:05

CQ10 59

1.

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epileptic activity and seizures1 targeted temperature managementTTM mildmoderate2 TTMTTM 32 10 42 13-16 303633 11248 0.51 / 324 21 50% 17 40.5%

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059-061-12_CQ10.indd 60 2017/06/01 21:09:31

CQ10 61

4 9.5% 15 35.7% 511.9% 3


1 Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet

2008 ; 371 : 1955-69. 2 Nunnally ME, Jaeschke R, Bellingan GJ, et al. Targeted temperature management in critical care : a report and recommenda-

tions from five professional societies. Crit Care Med 2011 ; 39 : 1113-25. 3 Ren GP, Su YY, Tian F, et al. Early Hypothermia for Refractory Status Epilepticus. Chin Med J Engl 2015 ; 128 : 1679-82.4

4 Bennett AE, Hoesch RE, DeWitt LD, Afra P, Ansari SA. Therapeutic hypothermia for status epilepticus : A report, historical perspective, and review. Clin Neurol Neurosurg 2014 ; 126 : 103-9.4

5 Zhumadilov A, Gilman CP, Viderman D. Management of super-refractory status epilepticus with isoflurane and hypothermia. Front Neurol 2014 ; 5 : 286.4

6 Nagase H, Nishiyama M, Nakagawa T, Fujita K, Saji Y, Maruyama A. Midazolam fails to prevent neurological damage in chil-dren with convulsive refractory febrile status epilepticus. Pediatr Neurol 2014 ; 51 : 78-84.3

7 Guilliams K, Rosen M, Buttram S, et al. Hypothermia for pediatric refractory status epilepticus. Epilepsia 2013 ; 54 : 1586-94.4

8 Shein SL, Reynolds TQ, Gedela S, Kochanek PM, Bell MJ. Therapeutic hypothermia for refractory status epilepticus in a child with malignant migrating partial seizures of infancy and SCN1A mutation : a case report. Ther Hypothermia Temp Manag

2012 ; 2 : 144-9.4 9 Elting JW, Naalt J, Fock JM. Mild hypothermia for refractory focal status epilepticus in an infant with hemimegalencephaly.

Eur J Paediatr Neurol 2010 ; 14 : 452-5.410 Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care 2008 ; 9 : 189-97.4

11 Cereda C, Berger MM, Rossetti AO. Bowel ischemia : a rare complication of thiopental treatment for status epilepticus. Neuro-crit Care 2009 ; 10 : 355-8.4

12 Orlowski JP, Erenberg G, Lueders H, Cruse RP. Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med 1984 ; 12 : 367-72.4

13 Lin JJ, Lin KL, Hsia SH, Wang HS ; CHEESE Study Group. Therapeutic hypothermia for febrile infection-related epilepsy syndrome in two patients. Pediatr Neurol 2012 ; 47 : 448-50.4

14 Missert MJ, Qazi KJ, Ionita CC. Utilising therapeutic hypothermia in the control of non-convulsive status epilepticus in a pa-tient with Creutzfeldt-Jakob encephalopathy. BJMP 2012 ; 5 : a515.4

15 Vastola EF, Homan R, Rosen A. Inhibition of focal seizures by moderate hypothermia. A clinical and experimental study. Arch Neurol 1969 ; 20 : 430-9.4

16 Ito H, Mori K, Toda Y, Sugimoto M, Takahashi Y, Kuroda Y. A case of acute encephalitis with refractory, repetitive partial seizures, presenting autoantibody to glutamate receptor Gluepsilon2. Brain Dev 2005 ; 27 : 531-4.4

059-061-12_CQ10.indd 61 2017/06/01 21:09:31

62

1.CRPCTCQ13

2.MRI CQ13

351 201-35 1 35 06.7% 048.2% 016.0%

American Academy of Neurologya 116% Neurocritical Care Societyb

CQ11

B

B

062-068-13_CQ11.indd 62 2017/06/01 21:09:54

CQ11 63

/ / SE SE /

%

%

%

Aicardi 1961-1968 15y 1 239 7.5 0 12.1Dunn 1984-1986 1m-18y 30 114 5.3 0 7Yager 1985-1986 30 52 11.5 0 9.6Maytal 1985-1987 1m-18y 30 193 2.1 0 7.8Phillips 1983-1987 1m-14y 30 218 11.5 0 13.8Lacroix 1976-1986 3d-18y 30 153 0.7 0 26.8Kwong 1989-1993 2m-114m 30 37 10.8 0 21.6Eriksson 1980-1992 16y 30 65 4.6 1.5 12.3Scholtes 1980-1987 28d-15y 30 112 0.9 0 8.9Mah 1992-1997 1m-12y 30 59 3.4 0 3.4Tabarki 1990-1997 1-24m 30 139 10.1 0 18.7Garzon 1989-1993 30 37 8.1 0 10.8Ibrahim 1998-2002 30 24 4.2 0 16.7Karasalholu 1994-2001 1m-16y 30 83 1.2 2.4 9.6Chin 1998-2001 29d-15y 30 90 2.2 1.1 20Kwong 1997-2002 1m-15y 30 25 16 0 20Asadi-Pooya 1999-2004 1m-15y 30 135 3 0 7.4Gulati 1993-2000 1m-120m 30 30 6.7 6.7 10Kang 1995-2003 15y 30 189 4.2 0 5.3Chin 2002-2004 29d-15y 30 176 2.8 0 10.2Visudtibhan 1981-2000 1m-15y 30 32 3.1 0 0Siddiqui 2005-2007 2m-15y 30 125 3.2 0.8 39.2Lewena 2000-2004 10 542 1 0 3Lin 1999-2006 2m-18y 30 141 0 0 48.2Molinero 2013 1m-16y 30 47 2.1 0 17Besli 2008 1m-18y 15 56 1.8 0 1.8Singh 2001-2007 18y 30 144 1.4 0 9Nishiyama 2003-2005 31d-15y 30 120 2.5 0 10.8 2011-2013 1m-18y 15 177 0.6 0 14.1Kumar 2008-2009 6m-12y 30 70 8.6 0 38.6 2007-2011 1m-16y 20 59 0 1.7 1.7Kravljanac 1995-2011 0.2-18y 30 602 0.5 0 13.6Shah 1994-2004 18y 30 189 12.2 0 9Halawa 2011-2012 1m-12y 5 70 1.4 0 31.4Maegaki 2005-2010 1m-16y 30 201 0 1 3.5

1 m19ySE

1

062-068-13_CQ11.indd 63 2017/06/01 21:09:55

64

2015cCRP

124

36 642438% 2 60 19% 14 22, 4, 5, 7, 10, 12-14, 18, 21, 25, 26, 37, 38 20.9%2.162.8%American Academy of Neurologya 32%

1 35 06.7%

062-068-13_CQ11.indd 64 2017/06/01 21:09:55

CQ11 65

American Academy of Neurologya 2.5%

1 35 048.2%

American Academy of Neurologya 12.8% 2015c39 24 9417%

/

%

Dunn 60 32 32 53.3

Maytal 193 4 4 2.1

Phillips 43 27 27 62.8

Kwong 37 3 3 8.1

Maytal 51 9 9 17.6

Mah 59 15 15 25.4

Karasalholu 83 23 23 27.7

Garzon 37 1 1 2.7

Ibrahim 24 5 1 6 25

Gulati 30 1 1 3.3

Visudtibhan 32 3 3 9.4

Hussain 49 2 6 8 16.3

Molinero 47 8 8 17

Besli 56 12 12 21.4

2

062-068-13_CQ11.indd 65 2017/06/01 21:09:56

66

CQ12 1114077.5%36% 11.2% 22.2% 45%43.3%

European Society of Intensive Care Medicined 1 2941620.7% 704270 57 38 11 19 2 CQ13

062-068-13_CQ11.indd 66 2017/06/01 21:09:56

CQ11 67


1 Aicardi J, Chevrie JJ. Convulsive status epilepticus in infants and children. A study of 239 cases. Epilepsia 1970 ; 11 : 187-97.4

2 Dunn DW. Status epilepticus in children : etiology, clinical features, and outcome. J Child Neurol 1988 ; 3 : 167-73.4 3 Yager JY, Cheang M, Seshia SS. Status epilepticus in children. Can J Neurol Sci 1988 ; 15 : 402-5.4 4 Maytal J, Shinnar S, Mosh SL, Alvarez LA. Low morbidity and mortality of status epilepticus in children. Pediatrics

1989 ; 83 : 323-31.4 5 Phillips SA, Shanahan RJ. Etiology and mortality of status epilepticus in children. A recent update. Arch Neurol 1989 ; 46 : 74-

6.4 6 Lacroix J, Deal C, Gauthier M, Rousseau E, Farrell CA. Admissions to a pediatric intensive care unit for status epilepticus : a

10-year experience. Crit Care Med 1994 ; 22 : 827-32.4 7 Kwong KL, Lee SL, Yung A, Wong VC. Status epilepticus in 37 Chinese childr

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