A prespecified, timeline-based treatment protocol is safe and effective in controlling acute repetitive seizures in patients with established epilepsy who are not critically ill, according to a new study published in the Journal of Neurosciences in Rural Practice.
“External validation from other parts of the world/centers and a more diverse epilepsy population are required before generalizing the protocol into clinical practice,” the authors of the study wrote.
They performed a retrospective chart review to determine the efficacy of the protocol in patients aged 1 to 18 years. The first tier of the protocol focused on intravenous lorazepam, dose optimization of existing antiseizure drugs, and control of triggers such as acute febrile illness, and the second tier focused on adding 1 or 2 antiepileptic drugs that are commonly used in cases with seizure clusters or status epilepticus.
The team, led by Prateek Kumar Panda, MD, from the Department of Pediatrics, All India Institute of Medical Sciences in Rishikesh, analyzed 100 consecutive patients aged 1 to 18 years in North India and showed that the protocol was successful in 89 of them.
Of these, 43 had Lennox-Gastaut syndrome (LGS), 15 had epilepsy with sleep-related hyper motor epilepsy, 14 had myoclonic atonic seizures, 10 had Dravet syndrome, 6 had focal cortical dysplasia, 5 had structural epilepsy due to hypoglycemic brain injury during the neonatal period, 4 had multiple viable parenchymal neurocysticercoses with structural epilepsy, and 4 had focal epilepsy due to perinatal hypoxia and cerebral gliosis.
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The researchers also found that the absence of pre-existing drug-resistant epilepsy and the presence of acute febrile illness were associated with the success of the first tier of the treatment protocol.
The most common adverse effects that occurred during the first week of the protocol were excessive sedation, incoordination, gait instability, and irritability, which were seen in 29, 14, 11, and 5 patients, respectively.
Reference
Sharawat IK, Ramachandran A, Kumar V, Elwadhi A, Tomar A, Panda PK. Efficacy of a pre-specified timeline-based treatment protocol in children with acute repetitive seizures or seizure clusters. J Neurosci Rural Pract. Published online May 3, 2023. doi:10.25259/JNRP_49_2022
