In pediatric patients with convulsive refractory status epilepticus (rSE), both intermittent rSE and out-of-hospital rSE onset are independently associated with longer delays to administration of the first benzodiazepine (BZD) and the first non-BZD antiepileptic drug (AED), according to the results of a prospective, observational study published in Neurology.

The current study was performed between June 2011 and March 2017 in pediatric patients with rSE. A Cox proportional hazards model was used to assess all possible risk factors related to treatment delays. A total of 219 patients were evaluated, (52.5% male; median age, 3.9 years). In 64.4% (141 of 219) of participants, rSE began out of the hospital, and in 35.6% (78 of 219), rSE began in the hospital. Median time from seizure onset to treatment with first BZD was 16 minutes (range 5-45 minutes); 63 minutes (range 33-146 minutes) to first non-BZD AED; and 170 minutes (range 107-539 minutes) to first continuous infusion.

Factors linked to more delays in administration of first BZD were intermittent rSE (hazard ratio [HR] 1.54; 95% CI, 1.14-2.09; P =.0467) and out-of-hospital rSE onset (HR 1.5; 95% CI, 1.11-2.04; P =.0467). Factors associated with more delays in administration of the first non-BZD AED were intermittent rSE (HR 1.78; 95% CI, 1.322.4; P =.001) and out-of-hospital rSE onset (HR 2.25; 95% CI, 1.67-3.02; P =.0001). None of the factors evaluated were linked with delayed administration of continuous infusion.

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The investigators concluded that these findings should help identify targets for intervention to reduce the overall time to treatment in this population.


Sánchez Fernández I, Gaínza-Lein M, Abend NS, et al; Pediatric Status Epilepticus Research Group (pSERG). Factors associated with treatment delays in pediatric refractory convulsive status epilepticus. Neurology. 2018;90:e1692-e1701.