Review of the new APLS guideline (2022): Management of the convulsing child
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Authors
Rao, Tekki
Bacon, Melody
Appleton, Richard
Bangalore, Harish
Brand, Celia
Browning, Juliet
Chin, Richard Fm
Mahal, Satvinder
Estevan, Susana Saranga
McHale, Kirsten
Issue Date
2023-02
Type
Scientific Paper
Language
Keywords
neurology , paediatric emergency medicine , paediatrics , resuscitation.
Alternative Title
Abstract
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)
Description
Citation
Arch Dis Child Educ Pract Ed . 2023 Feb;108(1):43-48.