Abstracts

Rationale: Time to treatment is associated with status epilepticus (SE) duration. The objective of this study is to describe the time to treatment of the first benzodiazepine in repeated episodes of refractory convulsive SE as compared to the first refractory convulsive SE episode. Methods: We performed a prospective observational study identifying pediatric patients with repeated refractory convulsive SE at our center from 2011-2016. All included patients were treated with at least one benzodiazepine and at least one non-benzodiazepine medication during the initial presentation and during repeat episodes. Results: Out of 105 patients who presented with refractory convulsive SE, 15 patients (14.3%) had repeated refractory convulsive SE leading to treatment with at least two anti-seizure medications. The median (p25-p75) age was 4.9 (0.6-14.5) years at the first SE episode, and 10 (66.7%) were males. Prior to the first episode, 10 (35.7%) patients had epilepsy, 5 (17.9%) patients had at least one SE episode prior to the enrollment window, 12 (42.9%) patients were developmentally delayed, and 1 (3.6%) patient did not have any additional neurological baseline condition. The median number of overall SE episodes was 2 (range 2-17) per patient, and we included 54 episodes (SE onset was in-hospital in 20 patients and outside the hospital in 34). The median (p25-p75) treatment response time in 54 episodes was 10 (0-25.5) minutes. Six (40%) patients received on average faster treatment during repeated episodes, and 9 (60%) received slower treatment. Five patients had more than 1 SE episode starting in the hospital; out of these, 4 (80%) received on average faster treatment during repeated episodes and 1 (20%) received slower treatment. Seven patients had more than 1 episode starting in the pre-hospital setting; out of these, 2 (28.6%) received on average faster treatment during repeated episodes and 5 (71.4%) received slower treatment. Of the 34 episodes that had repeated SE onset outside the hospital, 32 (94.1%) received a rescue medication at home. Among those 32 episodes treated at home, 20 (62.5%) were treated with midazolam (13 intramuscular, 4 buccal, 3 nasal), 11 (34.3%) with diazepam (9 per rectum, 2 buccal), and 1 (3.1%) with lorazepam (gastrostomy tube). Among 20 episodes that started in the hospital, 16 (80%) episodes were treated with lorazepam (intravenous bolus), and 4 (20%) with diazepam (3 per rectum, 1 buccal). Conclusions: Time to treatment during repeated SE may be slower in the pre-hospital setting and faster in the in-hospital setting when compared to the first episode. Reasons for treatment delay in the pre-hospital setting are unclear, and further factor analyses are ongoing in an attempt to improve treatment times, as faster treatment may ultimately improve outcomes. (Funded by the Pediatric Epilepsy Research Foundation) Funding: Funded by the Pediatric Epilepsy Research Foundation