Efficacy of intravenous clonazepam for paediatric convulsive status epilepticus.


Journal

Developmental medicine and child neurology
ISSN: 1469-8749
Titre abrégé: Dev Med Child Neurol
Pays: England
ID NLM: 0006761

Informations de publication

Date de publication:
23 Jan 2024
Historique:
revised: 22 12 2023
received: 14 04 2023
accepted: 27 12 2023
medline: 24 1 2024
pubmed: 24 1 2024
entrez: 24 1 2024
Statut: aheadofprint

Résumé

To compare the efficacy of intravenous clonazepam (CLZ) for the initial management of convulsive status epilepticus (CSE) in children as a function of the first-line in-hospital dose used. This monocentric retrospective study included children who received a first dose of CLZ for CSE at Montpellier University Hospital, France, between January 2016 and June 2019. Data from medical records (clinical, treatment, course) were collected and compared as a function of the first CLZ dose used. Among the 310 children treated for CSE, 105 received at least one CLZ dose (median age 3 years; quartile 1-quartile 3 [Q1-Q3] = 1 years 2 months-6 years 6 months). Among these 105 patients, 24 (22%) received a dose less than 0.03 mg/kg (low dose) and 69 (65%) received a dose of at least 0.03 mg/kg (high dose). Seizure cessation rate was not different between the low- and high-dose groups (62.5% vs 76%; odds ratio 0.53, 95% confidence interval [CI] 0.19-1.44, p = 0.29). The administration of a second dose of CLZ was more frequent in the low- than the high-dose group (37.5% vs 16%; odds ratio 3.2, 95% CI 1.1-9.1, p = 0.04). Our study did not find any difference in seizure termination rate as a function of CLZ dose in children with CSE. However, a second CLZ dose was more frequently needed in the group receiving low (less than 0.03 mg/kg) CLZ.

Identifiants

pubmed: 38263722
doi: 10.1111/dmcn.15859
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024 Mac Keith Press.

Références

Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. The Lancet. 2006;368(9531):222-9.
Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus-Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-23.
Walker MC. Pathophysiology of status epilepticus. Neuroscience letters. 2018;667:84-91.
Singh A, Stredny CM, Loddenkemper T. Pharmacotherapy for pediatric convulsive status epilepticus. CNS drugs. 2020;34(1):47-63.
Ochoa JG, Kilgo WA. The role of benzodiazepines in the treatment of epilepsy. Current treatment options in neurology. 2016;18(4):1-11.
Prasad M, Krishnan PR, Sequeira R, Al-Roomi K. Anticonvulsant therapy for status epilepticus. Cochrane database of systematic reviews. 2014(9).
Shangguan Y, Liao H, Wang X. Clonazepam in the treatment of status epilepticus. Expert Review of Neurotherapeutics. 2015;15(7):733-40.
Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy currents. 2016;16(1):48-61.
Outin H, Guèye P, Alvarez V, Auvin S, Clair B, Convers P, et al. Prise en charge des états de mal épileptiques en préhospitalier, en structure d'urgence et en réanimation dans les 48 premières heures (à l'exclusion du nouveau-né et du nourrisson). Médecine Intensive Réanimation. 2020;29(3):135-72.
Outin H, Blanc T, Vinatier I. Prise en charge en situation d'urgence et en réanimation des états de mal épileptiques de l'adulte et de l'enfant (nouveau-né exclu). Recommandations formalisées d'experts sous l'égide de la Société de réanimation de langue française. Revue neurologique (Paris). 2009;165(4):297-305.
Tenaillon A, Ameri A, Baron D, Bernardin G, Clair B, Cohen S, et al. Prise en charge de l'état de mal épileptique (enfants-adultes). Réanimation Urgences. 1995;4(4, Part 2):387-96.
Trinka E, Kälviäinen R. 25 years of advances in the definition, classification and treatment of status epilepticus. Seizure. 2017;44:65-73.
McMullan J, Sasson C, Pancioli A, Silbergleit R. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Academic emergency medicine. 2010;17(6):575-82.
Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. New England journal of medicine. 2012;366(7):591-600.
Shorvon S, Baulac M, Cross H, Trinka E, Walker M, Affairs ToSEotICfE. The drug treatment of status epilepticus in Europe: consensus document from a workshop at the first London Colloquium on Status Epilepticus. Epilepsia. 2008;49(7):1277-85.
Rosenow F, Besser R, Hamer HM, Holtkamp M, Kluge S, Knake S, et al. Die Leitlinien der DGN - Status epilepticus im Erwachsenenalter. 2012 (12.03.2020). [cited 2022 sep 1]. Available at: http://www.dgn.org/leitlinien/2303-ll-2a-2012-status-epilepticus-im-erwachsenenalter.html.
Cerda JM, Argani MT, Llerda JM, Gonzalez FL, Puig XS, Rieger JS. The Spanish Society of Neurology's official clinical practice guidelines for epilepsy. Neurología (English Edition). 2016;31(2):121-9.
Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocritical care. 2012;17(1):3-23.
Alvarez V, Lee JW, Drislane FW, Westover MB, Novy J, Dworetzky BA, et al. Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: a multicenter comparison. Epilepsia. 2015;56(8):1275-85.
Navarro V, Dagron C, Elie C, Lamhaut L, Demeret S, Urien S, et al. Prehospital treatment with levetiracetam plus clonazepam or placebo plus clonazepam in status epilepticus (SAMUKeppra): a randomised, double-blind, phase 3 trial. The Lancet Neurology. 2016;15(1):47-55.
Gueye P, Concina F. Comparison Between Lorazepam, Clonazepam and Clonazepam + Fosphenytoin for the Treatment of Out-of-hospital Generalized Status Epilepticus. ClinicalTrials.gov Identifier: NCT01870024. [cited 2022 Sep 1]. Available from: https://clinicaltrials.gov/ct2/show/NCT01870024
Goodkin HP, Liu X, Holmes GL. Diazepam terminates brief but not prolonged seizures in young, naive rats. Epilepsia. 2003;44(8):1109-12.
Jones DM, Esmaeil N, Maren S, Macdonald RL. Characterization of pharmacoresistance to benzodiazepines in the rat Li-pilocarpine model of status epilepticus. Epilepsy research. 2002;50(3):301-12.
Hoffmann F, Schmalhofer M, Lehner M, Zimatschek S, Grote V, Reiter K. Comparison of the AVPU Scale and the Pediatric GCS in Prehospital Setting. Prehospital emergency care. 2016;20(4):493-8.
Riss J, Cloyd J, Gates J, Collins S. Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta neurologica scandinavica. 2008;118(2):69-86.
Navarro V, Mazoit J-X. Pharmacologie des agents utilisés dans l'état de mal épileptique. Revue Neurologique. 2009;165(4):355-65.
Seree E, Pisano P, Placidi M, Rahmani R, Barra Y. Identification of the human and animal hepatic cytochromes P450 involved in clonazepam metabolism. Fundamental & clinical pharmacology. 1993;7(2):69-75.
Dahlin MG, Åmark PE, Nergårdh AR. Reduction of seizures with low-dose clonazepam in children with epilepsy. Pediatric neurology. 2003;28(1):48-52.
Dreifuss FE, Penry JK, Rose SW, Kupferberg HJ, Dyken P, Sato S. Serum clonazepam concentrations in children with absence seizures. Neurology. 1975;25(3):255-.
Naito H, Wachi M, Nishida M. Clinical effects and plasma concentrations of long-term clonazepam monotherapy in previously untreated epileptics. Acta neurologica scandinavica. 1987;76(1):58-63.
Rylance G, Poulton J, Cherry R, Cullen R. Plasma concentrations of clonazepam after single rectal administration. Archives of disease in childhood. 1986;61(2):186-8.
Crevoisier C, Delisle M, Joseph I, Foletti G. Comparative single-dose pharmacokinetics of clonazepam following intravenous, intramuscular and oral administration to healthy volunteers. European neurology. 2003;49(3):173-7.
Neligan A, Noyce AJ, Gosavi TD, Shorvon SD, Köhler S, Walker MC. Change in mortality of generalized convulsive status epilepticus in high-income countries over time: a systematic review and meta-analysis. JAMA neurology. 2019;76(8):897-905.
Gaínza-Lein M, Fernández IS, Jackson M, Abend NS, Arya R, Brenton JN, et al. Association of time to treatment with short-term outcomes for pediatric patients with refractory convulsive status epilepticus. JAMA neurology. 2018;75(4):410-8.

Auteurs

Maxime Colmard (M)

Département de Neuropédiatrie, CHU de Montpellier, Montpellier, France.

François Rivier (F)

Département de Neuropédiatrie, CHU de Montpellier, Montpellier, France.
PhyMedExp, CNRS, INSERM, Université de Montpellier, Montpellier, France.

Gaëlle de Barry (G)

Département de Pharmacie clinique, CHU de Montpellier, Montpellier, France.

Agathe Roubertie (A)

Département de Neuropédiatrie, CHU de Montpellier, Montpellier, France.
INM, INSERM U1298, Université de Montpellier, Montpellier, France.

Sarai Urtiaga-Valle (S)

Département de Neuropédiatrie, CHU de Montpellier, Montpellier, France.

Blanca Mercedes-Alvarez (B)

Département de Neuropédiatrie, CHU de Montpellier, Montpellier, France.

Clementine Combes (C)

Département de Réanimation Pédiatrique, CHU de Montpellier, Montpellier, France.

Gilles Cambonie (G)

Département de Réanimation Pédiatrique, CHU de Montpellier, Montpellier, France.

Christophe Milesi (C)

Département de Réanimation Pédiatrique, CHU de Montpellier, Montpellier, France.

Pierre Meyer (P)

Département de Neuropédiatrie, CHU de Montpellier, Montpellier, France.
PhyMedExp, CNRS, INSERM, Université de Montpellier, Montpellier, France.

Classifications MeSH