Treatment of acute convulsive seizures and status epilepticus in childhood

Status epilepticus is the most common neuropediatric emergency. Since the approval of a prefabricated compound of buccal midazolam, this has become established for initial treatment by caregivers and first-responders. Other nonintravenous benzodiazepines, such as nasal midazolam or rectal diazepam show no differences in efficacy and can be used as an alternative. At the moment there are no current German guidelines available for the treatment of status epilepticus in children. Escalation of treatment with intravenous anticonvulsants is recommended after failure of benzodiazepines. In addition to phenytoin and phenobarbital, recent studies have shown that newer anticonvulsants, such as levetiracetam and lacosamide are effective. There are far fewer interactions of the new anticonvulsants and no risks of respiratory suppression or intoxication. Anesthetics are the next therapeutic option for refractory and super-refractory status epilepticus, as well as a ketogenic diet, immunomodulatory treatment, other oral anticonvulsants and epilepsy surgery.