Acute seizure management in children

Abstract

Children with intractable epilepsy have frequent hospital admissions secondary to acute exacerbation of seizures or status epilepticus. Delay in medical management can lead to permanent neurological damage. Randomized clinical trials demonstrate that benzodiazepines are still the cornerstones of the acute management of seizures, but treatment is still evolving owing to the approval of newer medications. A decade ago, approval of fosphenytoin, parental valproate and rectal diazepam made an impact in the acute management of seizures. The use of rectal diazepam and intranasal and buccal midazolam for acute repetitive seizures resulted in reduced hospital admissions. In recent years, intravenous levetiracetum has also had an impact in treating status epilepticus and acute exacerbation of seizures. However, larger, prospective, multicenter trials are required to prove the efficacy of newer agents in acute seizure management.