Emergency management of febrile status epilepticus: Results of the FEBSTAT study

Syndi Seinfeld, Shlomo Shinnar, Shumei Sun, Dale C. Hesdorffer, Xiaoyan Deng, Ruth C. Shinnar, Kathryn O'Hara, Douglas R. Nordli, L. Matthew Frank, William Gallentine, Solomon L. Moshe, John M. Pellock

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective Treatment of seizures varies by region, with no standard emergency treatment protocol. Febrile status epilepticus (FSE) is often a child's first seizure; therefore, families are rarely educated about emergency treatment. Methods From 2002 to 2010, 199 subjects, age 1 month to 6 years, were recruited as part of a prospective, multicenter study of consequences of FSE, which was defined as a febrile seizure or series of seizures lasting >30 min. The patients' charts were reviewed. No standardized treatment protocol was implemented for this observational study. Results One hundred seventy-nine children received at least one antiepileptic drug (AED) to terminate FSE, and more than one AED was required in 140 patients (70%). Median time from the seizure onset to first AED by emergency medical services (EMS) or emergency department (ED) was 30 min. Mean seizure duration was 81 min for subjects given medication prior to ED and 95 min for those who did not (p = 0.1). Median time from the first dose of AED to end of seizure was 38 min. Initial dose of lorazepam or diazepam was suboptimal in 32 (19%) of 166 patients. Ninety-five subjects (48%) received respiratory support by EMS or ED. Median seizure duration for the respiratory support group was 83 min; for the nonrespiratory support group the duration was 58 min (p-value < 0.001). Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration. Significance FSE rarely stops spontaneously, is fairly resistant to medications, and even with treatment persists for a significant period of time. The total seizure duration is composed of two separate factors, the time from seizure onset to AED initiation and the time from first AED to seizure termination. Earlier onset of treatment results in shorter total seizure duration. A standard prehospital treatment protocol should be used nationwide and education of EMS responders is necessary.

Original languageEnglish (US)
Pages (from-to)388-395
Number of pages8
JournalEpilepsia
Volume55
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Status Epilepticus
Seizures
Emergencies
Fever
Anticonvulsants
Emergency Medical Services
Clinical Protocols
Hospital Emergency Service
Emergency Treatment
Self-Help Groups
Lorazepam
Febrile Seizures
Diazepam
Multicenter Studies
Observational Studies
Therapeutics

Keywords

  • Pediatric
  • Prehospital
  • Seizure

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Seinfeld, S., Shinnar, S., Sun, S., Hesdorffer, D. C., Deng, X., Shinnar, R. C., ... Pellock, J. M. (2014). Emergency management of febrile status epilepticus: Results of the FEBSTAT study. Epilepsia, 55(3), 388-395. https://doi.org/10.1111/epi.12526

Emergency management of febrile status epilepticus : Results of the FEBSTAT study. / Seinfeld, Syndi; Shinnar, Shlomo; Sun, Shumei; Hesdorffer, Dale C.; Deng, Xiaoyan; Shinnar, Ruth C.; O'Hara, Kathryn; Nordli, Douglas R.; Frank, L. Matthew; Gallentine, William; Moshe, Solomon L.; Pellock, John M.

In: Epilepsia, Vol. 55, No. 3, 2014, p. 388-395.

Research output: Contribution to journalArticle

Seinfeld, S, Shinnar, S, Sun, S, Hesdorffer, DC, Deng, X, Shinnar, RC, O'Hara, K, Nordli, DR, Frank, LM, Gallentine, W, Moshe, SL & Pellock, JM 2014, 'Emergency management of febrile status epilepticus: Results of the FEBSTAT study', Epilepsia, vol. 55, no. 3, pp. 388-395. https://doi.org/10.1111/epi.12526
Seinfeld, Syndi ; Shinnar, Shlomo ; Sun, Shumei ; Hesdorffer, Dale C. ; Deng, Xiaoyan ; Shinnar, Ruth C. ; O'Hara, Kathryn ; Nordli, Douglas R. ; Frank, L. Matthew ; Gallentine, William ; Moshe, Solomon L. ; Pellock, John M. / Emergency management of febrile status epilepticus : Results of the FEBSTAT study. In: Epilepsia. 2014 ; Vol. 55, No. 3. pp. 388-395.
@article{8d1db3cde1fe4c3da5f7ce08e243e700,
title = "Emergency management of febrile status epilepticus: Results of the FEBSTAT study",
abstract = "Objective Treatment of seizures varies by region, with no standard emergency treatment protocol. Febrile status epilepticus (FSE) is often a child's first seizure; therefore, families are rarely educated about emergency treatment. Methods From 2002 to 2010, 199 subjects, age 1 month to 6 years, were recruited as part of a prospective, multicenter study of consequences of FSE, which was defined as a febrile seizure or series of seizures lasting >30 min. The patients' charts were reviewed. No standardized treatment protocol was implemented for this observational study. Results One hundred seventy-nine children received at least one antiepileptic drug (AED) to terminate FSE, and more than one AED was required in 140 patients (70{\%}). Median time from the seizure onset to first AED by emergency medical services (EMS) or emergency department (ED) was 30 min. Mean seizure duration was 81 min for subjects given medication prior to ED and 95 min for those who did not (p = 0.1). Median time from the first dose of AED to end of seizure was 38 min. Initial dose of lorazepam or diazepam was suboptimal in 32 (19{\%}) of 166 patients. Ninety-five subjects (48{\%}) received respiratory support by EMS or ED. Median seizure duration for the respiratory support group was 83 min; for the nonrespiratory support group the duration was 58 min (p-value < 0.001). Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration. Significance FSE rarely stops spontaneously, is fairly resistant to medications, and even with treatment persists for a significant period of time. The total seizure duration is composed of two separate factors, the time from seizure onset to AED initiation and the time from first AED to seizure termination. Earlier onset of treatment results in shorter total seizure duration. A standard prehospital treatment protocol should be used nationwide and education of EMS responders is necessary.",
keywords = "Pediatric, Prehospital, Seizure",
author = "Syndi Seinfeld and Shlomo Shinnar and Shumei Sun and Hesdorffer, {Dale C.} and Xiaoyan Deng and Shinnar, {Ruth C.} and Kathryn O'Hara and Nordli, {Douglas R.} and Frank, {L. Matthew} and William Gallentine and Moshe, {Solomon L.} and Pellock, {John M.}",
year = "2014",
doi = "10.1111/epi.12526",
language = "English (US)",
volume = "55",
pages = "388--395",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Emergency management of febrile status epilepticus

T2 - Results of the FEBSTAT study

AU - Seinfeld, Syndi

AU - Shinnar, Shlomo

AU - Sun, Shumei

AU - Hesdorffer, Dale C.

AU - Deng, Xiaoyan

AU - Shinnar, Ruth C.

AU - O'Hara, Kathryn

AU - Nordli, Douglas R.

AU - Frank, L. Matthew

AU - Gallentine, William

AU - Moshe, Solomon L.

AU - Pellock, John M.

PY - 2014

Y1 - 2014

N2 - Objective Treatment of seizures varies by region, with no standard emergency treatment protocol. Febrile status epilepticus (FSE) is often a child's first seizure; therefore, families are rarely educated about emergency treatment. Methods From 2002 to 2010, 199 subjects, age 1 month to 6 years, were recruited as part of a prospective, multicenter study of consequences of FSE, which was defined as a febrile seizure or series of seizures lasting >30 min. The patients' charts were reviewed. No standardized treatment protocol was implemented for this observational study. Results One hundred seventy-nine children received at least one antiepileptic drug (AED) to terminate FSE, and more than one AED was required in 140 patients (70%). Median time from the seizure onset to first AED by emergency medical services (EMS) or emergency department (ED) was 30 min. Mean seizure duration was 81 min for subjects given medication prior to ED and 95 min for those who did not (p = 0.1). Median time from the first dose of AED to end of seizure was 38 min. Initial dose of lorazepam or diazepam was suboptimal in 32 (19%) of 166 patients. Ninety-five subjects (48%) received respiratory support by EMS or ED. Median seizure duration for the respiratory support group was 83 min; for the nonrespiratory support group the duration was 58 min (p-value < 0.001). Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration. Significance FSE rarely stops spontaneously, is fairly resistant to medications, and even with treatment persists for a significant period of time. The total seizure duration is composed of two separate factors, the time from seizure onset to AED initiation and the time from first AED to seizure termination. Earlier onset of treatment results in shorter total seizure duration. A standard prehospital treatment protocol should be used nationwide and education of EMS responders is necessary.

AB - Objective Treatment of seizures varies by region, with no standard emergency treatment protocol. Febrile status epilepticus (FSE) is often a child's first seizure; therefore, families are rarely educated about emergency treatment. Methods From 2002 to 2010, 199 subjects, age 1 month to 6 years, were recruited as part of a prospective, multicenter study of consequences of FSE, which was defined as a febrile seizure or series of seizures lasting >30 min. The patients' charts were reviewed. No standardized treatment protocol was implemented for this observational study. Results One hundred seventy-nine children received at least one antiepileptic drug (AED) to terminate FSE, and more than one AED was required in 140 patients (70%). Median time from the seizure onset to first AED by emergency medical services (EMS) or emergency department (ED) was 30 min. Mean seizure duration was 81 min for subjects given medication prior to ED and 95 min for those who did not (p = 0.1). Median time from the first dose of AED to end of seizure was 38 min. Initial dose of lorazepam or diazepam was suboptimal in 32 (19%) of 166 patients. Ninety-five subjects (48%) received respiratory support by EMS or ED. Median seizure duration for the respiratory support group was 83 min; for the nonrespiratory support group the duration was 58 min (p-value < 0.001). Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration. Significance FSE rarely stops spontaneously, is fairly resistant to medications, and even with treatment persists for a significant period of time. The total seizure duration is composed of two separate factors, the time from seizure onset to AED initiation and the time from first AED to seizure termination. Earlier onset of treatment results in shorter total seizure duration. A standard prehospital treatment protocol should be used nationwide and education of EMS responders is necessary.

KW - Pediatric

KW - Prehospital

KW - Seizure

UR - http://www.scopus.com/inward/record.url?scp=84896341601&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896341601&partnerID=8YFLogxK

U2 - 10.1111/epi.12526

DO - 10.1111/epi.12526

M3 - Article

C2 - 24502379

AN - SCOPUS:84896341601

VL - 55

SP - 388

EP - 395

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 3

ER -