Clinical Effectiveness and Safety of Midazolam Infusion and Topiramate Add-on Therapy against Refractory Status Epilepticus in Children

Hwang, Su Kyeong; Seo, Hye Eun; Park, Sung Pa; Kwon, Soonhak

Abstract

PURPOSE
This study was aimed to evaluate the effectiveness and safety of midazolam infusion and topiramate add-on therapy for refractory status epilepticus (RSE) in children.
METHODS
Nineteen children were involved in the study and their clinical data were retrospectively analyzed. After failure of initial conventional treatment, all of the children were given midazolam (MDZ) infusion, titrated until a response is achieved or maximum dose of 20 mcg/kg/min. Eleven children were given additional topiramate (TPM) at 1-2mg/kg/day by nasogastric and titrated to the favorable response every 1-3 days. We subdivided the children into 2 groups by whether TPM added (TPM group) or not (MDZ group) and compared them each other.
RESULTS
The age of subjects ranged from 2 to 175 months (54.9+/-53.3 months; male 10, female 9). Seizure duration of initial presentation ranged from 30 to 1,440 minutes (218.4+/-432.9 minutes). Seizure types were convulsive in 16 children (84%) and 3 were non-convulsive (16%). In the MDZ group (4.0+/-2.9 mcg/kg/minutes), time to seizure control ranged from 1 day to 2 days (1.1+/-0.4 days), but seizures recurred in 50 %. In the TPM group (6.3+/-1.5 mg/kg/day), time to seizure control ranged from 1 day to 5 days (1.9+/-1.5 days), but seizures recurred in 36%. 1 child (5.3%) died of sepsis and 7 children (36.8%) experienced cardio-respiratoty compromise. 7 children (63.6%) in the TPM group recovered completely to baseline neurological function.
CONCLUSIONS
The results indicate that midazolam infusion is still the mainstay of treatment, but TPM add-on therapy seems to be a useful option in RSE. However, further studies are needed to establish its precise role and safety.