Characteristics of withdrawal seizures in children with refractory status epilepticus who responded favorably to continuous midazolam therapy

IF 1.4 4区医学 Q4 CLINICAL NEUROLOGY

Brain & Development Pub Date : 2025-07-11 DOI:10.1016/j.braindev.2025.104394

Hirokazu Takeuchi , Kenjiro Kikuchi , Rikako Takeda , Yuko Hirata , Ryuki Matsuura , Reiko Koichihara , Ikuya Ueta , Shin-Ichiro Hamano

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引用次数: 0

Abstract

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.

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难治性癫痫持续状态患儿对持续咪达唑仑治疗反应良好的戒断性癫痫发作特征

本研究探讨难治性癫痫持续状态（RSE）患儿的特点，这些患儿经历过戒断性癫痫发作，并对持续咪达唑仑（cMDL）治疗反应良好。方法将经历RSE并使用cMDL实现癫痫停止的患者纳入研究。戒断性癫痫发作定义为从cMDL开始逐渐减少到停药后48小时发生的癫痫发作。将患者分为癫痫停止组和癫痫戒断组。结果19例RSE患者经cMDL治疗后癫痫发作停止。癫痫停止组11例，停药组8例（42.1%）。停药组cMDL的中位维持剂量为0.1 mg/kg/h（四分位数范围[IQR]: 0.1 - 0.2），停药组为0.25 mg/kg/h （IQR: 0.15-0.3）。停止发作组的中位维持时间为27小时（IQR: 12-32.5），戒断发作组的中位维持时间为52.5小时（IQR: 23-65.5）。停止发作组的中位累积MDL为2.7 mg/kg (IQR: 1.6-4.9)，而停止发作组的中位累积MDL为11.6 mg/kg （IQR: 4.5-24.5）。结论cMDL维持剂量与戒断性癫痫发作存在潜在的相关性，但样本量小，未进行统计分析。多中心、大样本量的研究和对这种关系的统计分析可能有助于建立优化的cMDL减径方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brain & Development 医学-临床神经学

CiteScore

3.60

自引率

0.00%

发文量

153

审稿时长

50 days

期刊介绍： Brain and Development (ISSN 0387-7604) is the Official Journal of the Japanese Society of Child Neurology, and is aimed to promote clinical child neurology and developmental neuroscience. The journal is devoted to publishing Review Articles, Full Length Original Papers, Case Reports and Letters to the Editor in the field of Child Neurology and related sciences. Proceedings of meetings, and professional announcements will be published at the Editor''s discretion. Letters concerning articles published in Brain and Development and other relevant issues are also welcome.