Abstracts

Rationale: To assess the frequency of rescue medication use for prolonged seizures or seizure clusters in children admitted to the pediatric epilepsy monitoring unit (PEMU). Methods: Records of all children undergoing prolonged, inpatient, video-EEG monitoring Mayo Clinic Rochester between 01/01/2012 and 12/31/2013 were reviewed and those admitted under the PEMU service with recorded generalized tonic, clonic, tonic-clonic, atonic or focal seizures on scalp recording were selected for study. Rescue medication use was documented and risk factors for rescue medication use were evaluated. Results: Of 729 children undergoing video-EEG monitoring, 150 (20.6%) children were admitted under the PEMU service had recorded generalized tonic, clonic, tonic-clonic, atonic or focal seizures. For this selected group, mean duration of stay was 2.5 days (SD 2.4), mean age at admission was 8.8 years (SD 4.9) and 50.3% were male. Epilepsy was generalized in 26 (17.3%), focal in 111 (74.0%) and unknown in 13 (8.6%). MRI showed structural abnormalities in 74/139 cases (53.2%). Nineteen children (12.7%) had prior status epilepticus and 25 (16.7%) used rescue medication at least monthly. Fifteen of 150 (10.0%) children required rescue medication, 6 for prolonged seizures and 9 for seizure clusters. Amongst children with recorded seizures, risk factors for rescue medication use included weaning of AEDs both on the first day (p=0.001) and within 3 days of admission (p=0.001), structural etiology (p=0.019) and home seizure frequency less than daily (p=0.013). Additionally, older age at monitoring showed a nonsignificant trend toward greater use of rescue medication (p=0.07). Neither age at seizure onset, a history of prior status epilepticus, frequency of home rescue medication use, abnormal neurological exam, seizure type or number of failed AEDs were predictive of higher rates of rescue medication use in the PEMU. Conclusions: Ten percent of children with seizures recorded in the PEMU will require rescue medication. The biggest risk factor is weaning of current AEDs, however those with structural etiology and less than daily seizure frequency are also at higher risk. IV access should be maintained in all children weaning medication, and a clear rescue plan must be in place.