To determine efficacy of continuous
diazepam infusion in the treatment of refractory
status epilepticus in a retrospective study, we analyzed data of 62 children admitted consecutively to our Pediatric Intensive Care Unit with a diagnosis of refractory
status epilepticus. The unit followed a standard treatment protocol for
diazepam infusion; if it failed,
thiopental infusion was used. The mean age of patients was 2.80 years (range, 1.5 to 11.5 yr). Thirty-six patients (60%) had acute
infections of the central nervous system and 10 (16%) had idiopathic
epilepsy.
Diazepam infusion was used in 57 patients. This treatment controlled
seizures in 86% of patients (49/57), on average within 40 minutes (median, 30 min; range, 10-120 min), at a mean infusion rate of 0.017 mg/kg/min (range, 0.01-0.03 mg/kg/min). The mean total duration of infusion was 68 hours (range, 12-220 hr).
Diazepam infusion was associated with
hypotension in one patient,
respiratory depression requiring ventilatory support in 12% of patients (6/49), and death in 14% of patients (7/49).
Thiopental infusion was used in nine patients, including eight in whom
diazepam infusion had failed.
Thiopental infusion controlled
seizures in all nine patients, but all of them needed
mechanical ventilation, and seven needed vasopressor support for
hypotension; four patients (44%) died. We conclude that continuous
diazepam infusion is a reasonably effective modality to control refractory
status epilepticus in children and is associated with reduced need for ventilatory and vasopressor support.