Brain & development · 2025
Characteristics of withdrawal seizures in children with refractory status epilepticus who responded favorably to continuous midazolam therapy.
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Takeuchi Hirokazu, Kikuchi Kenjiro, Takeda Rikako, Hirata Yuko, Matsuura Ryuki, Koichihara Reiko, Ueta Ikuya, Hamano Shin-Ichiro
Аннотация
BACKGROUND: This study investigates the characteristics of children with refractory status epilepticus (RSE) who experienced withdrawal seizures and responded favorably to continuous midazolam (cMDL) therapy.
METHODS: Patients who experienced RSE and achieved seizure cessation with cMDL were included in the study. Withdrawal seizure was defined as a seizure occurring from the initiation of cMDL tapering until 48 h after the discontinuation of cMDL. The patients were categorized into two groups: seizure cessation and withdrawal seizure groups.
RESULTS: Nineteen patients with RSE achieved seizure cessation with cMDL. The seizure cessation group comprised 11 patients, while eight patients (42.1 %) were classified into the withdrawal seizure group. The median maintenance dose of cMDL were 0.1 mg/kg/h (interquartile range [IQR]: 0.1-0.2) for the seizure cessation group, and 0.25 mg/kg/h (IQR: 0.15-0.3) for the withdrawal seizure group. The median maintenance periods were 27 h (IQR: 12-32.5) for the seizure cessation group, and 52.5 h (IQR: 23-65.5) for the withdrawal seizure group. The seizure cessation group had a median cumulative MDL of 2.7 mg/kg (IQR: 1.6-4.9), while the withdrawal seizure group had 11.6 mg/kg (IQR: 4.5-24.5).
CONCLUSION: Although statistical analysis was not conducted due to the small sample size, maintenance dose of cMDL is potentially correlated with withdrawal seizure. A multi-center study with large sample size and statistical analysis of this relationship may contribute to the establishment of an optimized cMDL tapering protocol.
METHODS: Patients who experienced RSE and achieved seizure cessation with cMDL were included in the study. Withdrawal seizure was defined as a seizure occurring from the initiation of cMDL tapering until 48 h after the discontinuation of cMDL. The patients were categorized into two groups: seizure cessation and withdrawal seizure groups.
RESULTS: Nineteen patients with RSE achieved seizure cessation with cMDL. The seizure cessation group comprised 11 patients, while eight patients (42.1 %) were classified into the withdrawal seizure group. The median maintenance dose of cMDL were 0.1 mg/kg/h (interquartile range [IQR]: 0.1-0.2) for the seizure cessation group, and 0.25 mg/kg/h (IQR: 0.15-0.3) for the withdrawal seizure group. The median maintenance periods were 27 h (IQR: 12-32.5) for the seizure cessation group, and 52.5 h (IQR: 23-65.5) for the withdrawal seizure group. The seizure cessation group had a median cumulative MDL of 2.7 mg/kg (IQR: 1.6-4.9), while the withdrawal seizure group had 11.6 mg/kg (IQR: 4.5-24.5).
CONCLUSION: Although statistical analysis was not conducted due to the small sample size, maintenance dose of cMDL is potentially correlated with withdrawal seizure. A multi-center study with large sample size and statistical analysis of this relationship may contribute to the establishment of an optimized cMDL tapering protocol.