Review of the new APLS guideline (2022): Management of the convulsing child

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Rao, Tekki
Bacon, Melody
Appleton, Richard
Bangalore, Harish
Brand, Celia
Browning, Juliet
Chin, Richard Fm
Mahal, Satvinder
Estevan, Susana Saranga
McHale, Kirsten
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Background Convulsive status epilepticus (CSE) (box 1) is the most common childhood medical neurological emergency, with an incidence of approximately 20 per 100 000 per year in the developed world.1 2 Box 1 Definition of status epilepticus Status epilepticus is a condition resulting either from failure of the mechanism responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally prolonged seizures (after time point t1 at 5 min). It is a condition, which can have long-term consequences (after time point t2 after 30 min) including neuronal death, neuronal injury and alteration of neuronal networks, depending on the type and duration of seizures. CSE can be fatal, but mortality is lower in children than in adults—at about 2%–7%.3 Adverse neurological consequences following CSE consist of subsequent epilepsy, motor deficits, and learning and behavioural difficulties. The main determinant of outcome is the underlying aetiology (box 2). There is low risk of morbidity and mortality in children with unprovoked/prolonged febrile CSE. This risk increases significantly in cases with structural or genetic causes. Box 2 Common causes of status epilepticus Known (ie, symptomatic) Structural: Intracranial tumour, cerebrovascular disease, head injury, cortical dysplasia Infectious: CNS infection (meningitis, encephalitis), tuberculosis, cerebral malaria Metabolic: Metabolic disturbance (electrolyte imbalance, glucose imbalance, organ failure, etc), metabolic disorders, anoxic injury, mitochondrial disorders Toxicity or drug-related: Low or high level of antiseizure medication, withdrawal of antiseizure medication, other drug/alcohol overdose, neurotoxins and poisons Inflammatory: Autoimmune disorders, neurocutaneous disorders Genetic: Dravet syndrome, ring chromosome 20, Angelman syndrome, fragile X syndrome, Rett syndrome, trisomy 21 Unknown (ie, cryptogenic)
neurology , paediatric emergency medicine , paediatrics , resuscitation.
Arch Dis Child Educ Pract Ed . 2023 Feb;108(1):43-48.