Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus

Masahiro Nishiyama, Hiroaki Nagase, Kazumi Tomioka, Tsukasa Tanaka, Hiroshi Yamaguchi, Yusuke Ishida, Daisaku Toyoshima, Kyoko Fujita, Azusa Maruyama, Hiroshi Kurosawa, Yoshiyuki Uetani, Kandai Nozu, Mariko Ikeda, Ichiro Morioka, Satoshi Takada, Kazumoto Iijima

Research output: Contribution to journalArticle

Abstract

Background: Fosphenytoin (fPHT) and continuous intravenous midazolam (cMDL) had commonly been used as second-line treatments for pediatric status epilepticus (SE) in Japan. However, there is no comparative study of these two treatments. Methods: We included consecutive children who 1) were admitted to Kobe Children's Hospital because of convulsion with fever and 2) were treated with either fPHT or cMDL as second-line treatment for convulsive SE lasting for longer than 30 min. We compared, between the fPHT and cMDL groups, the proportion of barbiturate coma therapy (BCT), incomplete recovery of consciousness, mechanical ventilation, and inotropic agents. Results: The proportion of BCT was not significantly different between the two groups (48.7% [20/41] in fPHT and 35.3% [29/82] in cMDL, p = 0.17). The prevalence of incomplete recovery of consciousness, mechanical ventilation, and inotropic agents was not different between the two groups. After excluding 49 patients treated with BCT, incomplete recovery of consciousness 6 h and 12 h after onset was more frequent in the cMDL group than in the fPHT group (71.7% vs. 33.3%, p < 0.01; 56.6% vs. 14.2%, p < 0.01; respectively). Mechanical ventilation was more frequent in the cMDL group than in the fPHT group (32.0% vs. 4.7%, p = 0.01). Conclusions: Our results suggest that 1) the efficacy of fPHT and cMDL is similar, although cMDL may prevent the need for BCT compared with fPHT, and 2) fPHT is relatively safe as a second-line treatment for pediatric SE in patients who do not require BCT.

Original languageEnglish
Pages (from-to)884-890
Number of pages7
JournalBrain and Development
Volume40
Issue number10
DOIs
Publication statusPublished - 01-11-2018

Fingerprint

Status Epilepticus
Midazolam
Fever
Pediatrics
Coma
Consciousness
Artificial Respiration
Therapeutics
fosphenytoin
Febrile Seizures
Japan
barbituric acid

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Clinical Neurology

Cite this

Nishiyama, M., Nagase, H., Tomioka, K., Tanaka, T., Yamaguchi, H., Ishida, Y., ... Iijima, K. (2018). Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus. Brain and Development, 40(10), 884-890. https://doi.org/10.1016/j.braindev.2018.08.001
Nishiyama, Masahiro ; Nagase, Hiroaki ; Tomioka, Kazumi ; Tanaka, Tsukasa ; Yamaguchi, Hiroshi ; Ishida, Yusuke ; Toyoshima, Daisaku ; Fujita, Kyoko ; Maruyama, Azusa ; Kurosawa, Hiroshi ; Uetani, Yoshiyuki ; Nozu, Kandai ; Ikeda, Mariko ; Morioka, Ichiro ; Takada, Satoshi ; Iijima, Kazumoto. / Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus. In: Brain and Development. 2018 ; Vol. 40, No. 10. pp. 884-890.
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abstract = "Background: Fosphenytoin (fPHT) and continuous intravenous midazolam (cMDL) had commonly been used as second-line treatments for pediatric status epilepticus (SE) in Japan. However, there is no comparative study of these two treatments. Methods: We included consecutive children who 1) were admitted to Kobe Children's Hospital because of convulsion with fever and 2) were treated with either fPHT or cMDL as second-line treatment for convulsive SE lasting for longer than 30 min. We compared, between the fPHT and cMDL groups, the proportion of barbiturate coma therapy (BCT), incomplete recovery of consciousness, mechanical ventilation, and inotropic agents. Results: The proportion of BCT was not significantly different between the two groups (48.7{\%} [20/41] in fPHT and 35.3{\%} [29/82] in cMDL, p = 0.17). The prevalence of incomplete recovery of consciousness, mechanical ventilation, and inotropic agents was not different between the two groups. After excluding 49 patients treated with BCT, incomplete recovery of consciousness 6 h and 12 h after onset was more frequent in the cMDL group than in the fPHT group (71.7{\%} vs. 33.3{\%}, p < 0.01; 56.6{\%} vs. 14.2{\%}, p < 0.01; respectively). Mechanical ventilation was more frequent in the cMDL group than in the fPHT group (32.0{\%} vs. 4.7{\%}, p = 0.01). Conclusions: Our results suggest that 1) the efficacy of fPHT and cMDL is similar, although cMDL may prevent the need for BCT compared with fPHT, and 2) fPHT is relatively safe as a second-line treatment for pediatric SE in patients who do not require BCT.",
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Nishiyama, M, Nagase, H, Tomioka, K, Tanaka, T, Yamaguchi, H, Ishida, Y, Toyoshima, D, Fujita, K, Maruyama, A, Kurosawa, H, Uetani, Y, Nozu, K, Ikeda, M, Morioka, I, Takada, S & Iijima, K 2018, 'Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus', Brain and Development, vol. 40, no. 10, pp. 884-890. https://doi.org/10.1016/j.braindev.2018.08.001

Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus. / Nishiyama, Masahiro; Nagase, Hiroaki; Tomioka, Kazumi; Tanaka, Tsukasa; Yamaguchi, Hiroshi; Ishida, Yusuke; Toyoshima, Daisaku; Fujita, Kyoko; Maruyama, Azusa; Kurosawa, Hiroshi; Uetani, Yoshiyuki; Nozu, Kandai; Ikeda, Mariko; Morioka, Ichiro; Takada, Satoshi; Iijima, Kazumoto.

In: Brain and Development, Vol. 40, No. 10, 01.11.2018, p. 884-890.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus

AU - Nishiyama, Masahiro

AU - Nagase, Hiroaki

AU - Tomioka, Kazumi

AU - Tanaka, Tsukasa

AU - Yamaguchi, Hiroshi

AU - Ishida, Yusuke

AU - Toyoshima, Daisaku

AU - Fujita, Kyoko

AU - Maruyama, Azusa

AU - Kurosawa, Hiroshi

AU - Uetani, Yoshiyuki

AU - Nozu, Kandai

AU - Ikeda, Mariko

AU - Morioka, Ichiro

AU - Takada, Satoshi

AU - Iijima, Kazumoto

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: Fosphenytoin (fPHT) and continuous intravenous midazolam (cMDL) had commonly been used as second-line treatments for pediatric status epilepticus (SE) in Japan. However, there is no comparative study of these two treatments. Methods: We included consecutive children who 1) were admitted to Kobe Children's Hospital because of convulsion with fever and 2) were treated with either fPHT or cMDL as second-line treatment for convulsive SE lasting for longer than 30 min. We compared, between the fPHT and cMDL groups, the proportion of barbiturate coma therapy (BCT), incomplete recovery of consciousness, mechanical ventilation, and inotropic agents. Results: The proportion of BCT was not significantly different between the two groups (48.7% [20/41] in fPHT and 35.3% [29/82] in cMDL, p = 0.17). The prevalence of incomplete recovery of consciousness, mechanical ventilation, and inotropic agents was not different between the two groups. After excluding 49 patients treated with BCT, incomplete recovery of consciousness 6 h and 12 h after onset was more frequent in the cMDL group than in the fPHT group (71.7% vs. 33.3%, p < 0.01; 56.6% vs. 14.2%, p < 0.01; respectively). Mechanical ventilation was more frequent in the cMDL group than in the fPHT group (32.0% vs. 4.7%, p = 0.01). Conclusions: Our results suggest that 1) the efficacy of fPHT and cMDL is similar, although cMDL may prevent the need for BCT compared with fPHT, and 2) fPHT is relatively safe as a second-line treatment for pediatric SE in patients who do not require BCT.

AB - Background: Fosphenytoin (fPHT) and continuous intravenous midazolam (cMDL) had commonly been used as second-line treatments for pediatric status epilepticus (SE) in Japan. However, there is no comparative study of these two treatments. Methods: We included consecutive children who 1) were admitted to Kobe Children's Hospital because of convulsion with fever and 2) were treated with either fPHT or cMDL as second-line treatment for convulsive SE lasting for longer than 30 min. We compared, between the fPHT and cMDL groups, the proportion of barbiturate coma therapy (BCT), incomplete recovery of consciousness, mechanical ventilation, and inotropic agents. Results: The proportion of BCT was not significantly different between the two groups (48.7% [20/41] in fPHT and 35.3% [29/82] in cMDL, p = 0.17). The prevalence of incomplete recovery of consciousness, mechanical ventilation, and inotropic agents was not different between the two groups. After excluding 49 patients treated with BCT, incomplete recovery of consciousness 6 h and 12 h after onset was more frequent in the cMDL group than in the fPHT group (71.7% vs. 33.3%, p < 0.01; 56.6% vs. 14.2%, p < 0.01; respectively). Mechanical ventilation was more frequent in the cMDL group than in the fPHT group (32.0% vs. 4.7%, p = 0.01). Conclusions: Our results suggest that 1) the efficacy of fPHT and cMDL is similar, although cMDL may prevent the need for BCT compared with fPHT, and 2) fPHT is relatively safe as a second-line treatment for pediatric SE in patients who do not require BCT.

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Nishiyama M, Nagase H, Tomioka K, Tanaka T, Yamaguchi H, Ishida Y et al. Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus. Brain and Development. 2018 Nov 1;40(10):884-890. https://doi.org/10.1016/j.braindev.2018.08.001