TABLE 1215 Doses for Status Epilepticus in Children

Side-effect profile, physician preference, and parental experience and comfort usually dictate which AED will be used initially. Phenytoin and carbamazepine have a similar mechanism of action and effectiveness; therefore, their side-effect profiles will determine which to initiate. Phenobarbital is quite effective and, though a sedative, in some may create more problems of irritability and limit its effectiveness. Nonetheless, it can be well tolerated in the majority of infants and children and has a wide spectrum of effectiveness. See Iabl.e.12.1:2 for the clinical pathway in management of new-onset seizures.

Absence seizures (petit mal) rarely require emergency care, and an EEG should be obtained for confirmation before one starts AEDs, since absence seizures could mimic partial status and an AED such as ethosuximide will be ineffective. Valproate, ethosuximide and, more recently, lamotrigine are the appropriate AEDs for absence epilepsy chronic management, with the benzodiazepines effective in the acute management of status absence epilepticus.

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