Seizures & status epilepticus (paeds)
also: buccal midazolam · status epilepticus · sodium valproate · ethosuximide · AED
Overview
The status-epilepticus escalation ladder plus the maintenance antiepileptics by seizure type. The valproate teratogenicity restriction and the absence-seizure choice are heavily tested.
Mechanism
Benzodiazepines enhance GABA-A inhibition (abort seizures). Sodium valproate broadens inhibition (↑GABA, Na-channel) — broad spectrum. Ethosuximide blocks T-type calcium channels in thalamic neurones (absence). Carbamazepine/lamotrigine/phenytoin stabilise voltage-gated Na channels (focal/GTC).
Indications
- Status epilepticus (emergency)
- Maintenance therapy for epilepsy by seizure type
- Febrile convulsions (usually no regular treatment)
The agents
First benzodiazepine dose (home/ambulance).
repeat once after 10 min
In-hospital benzodiazepine.
If 2 benzo doses fail → call for help, prep for ICU/thiopental.
Broad-spectrum but TERATOGENIC — avoid in girls/women of childbearing potential (pregnancy prevention programme).
First-line for absence seizures.
Carbamazepine can WORSEN absence/myoclonic seizures.
Adverse effects
Plus weight gain, tremor, hepatotoxicity, hair loss, pancreatitis.
Cautions & contraindications
Teratogen — only under a pregnancy prevention programme when no alternative.
Can exacerbate them.
Interactions
- Carbamazepine/phenytoin induce CYP (↓OCP, ↓other AEDs)
- Valproate inhibits lamotrigine metabolism (↑SJS risk)
Monitoring & kinetics
Status: ABC, glucose, timing; phenytoin levels/ECG,Valproate: LFTs; pregnancy prevention
Status ladder: benzo → repeat benzo → phenytoin/levetiracetam → RSI/thiopental + ICU. Do not stop AEDs abruptly.
Source: NICE NG217 — Epilepsies · APLS — Status epilepticus