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New Guidelines for Status Epilepticus in Children

Physicians should consider EEG, testing levels of anti-epileptic drugs

MONDAY, Nov. 22 (HealthDay News) -- For children with treated epilepsy who develop status epilepticus, physicians should consider testing for levels of anti-epileptic drugs, which are low in 32 percent of children, according to guidelines from the American Academy of Neurology and the Child Neurology Society. The guidelines are published in the Nov. 14 issue of Neurology.

J.J. Riviello, Jr., M.D., of Harvard Medical School in Boston, and colleagues identified 25 articles that included at least 20 patients between the ages of 1 month to 19 years who had status epilepticus. Small samples with unusual pathological findings or articles that referred to febrile or refractory status epilepticus were excluded.

The investigators found that in children who were tested, 12.8 percent had a central nervous system infection and 2.5 percent had an abnormal blood culture. When anti-epileptic drug levels were tested in children known to have epilepsy, one-third had low levels. Forty-three percent of EEGs showed epileptiform abnormalities that helped determine the nature and location of the seizures. Other recommendations include the use of infectious, toxicological or metabolic studies when there are clinical indicators for concern or when the cause of the seizures is unknown.

Although blood cultures and lumbar punctures are often performed routinely, there are "insufficient data to support or refute" the tests in cases in which there is "no clinical suspicion of a systemic or central nervous system infection," the authors conclude.

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