[P3-97] Efficacy and Complications of Fosphenytoin versus Continuous Midazolam in Children with Febrile Status Epilepticus
[Introduction] Fosphenytoin (fPHT) or continuous midazolam (cMDL) are commonly used as second-line treatment after bolus infusion of benzodiazepine in children with febrile status epilepticus (FSE) in Japan. We compared the efficacy and complications of fPHT against cMDL.
[Methodology] We included the consecutive patients who: 1) were admitted to the Kobe Children’s Hospital due to convulsion or impaired consciousness with fever, 2) were from 1 month to 15 years, 3) were injected with either fPHT or cMDL after benzodiazepine administration. We excluded patients given ≥2 second-line treatments including fPHT, cMDL, phenytoin, or phenobarbital. We assessed the induction of barbiturate coma therapy representing failure of fPHT or cMDL for efficacy, mechanical ventilation representing respiratory depression, and the level of consciousness at 6 hours and 12 hours after initial neurologic symptoms representing CNS depression.
[Results] The number of patients in fPHT and cMDL was 45 and 97, respectively. Characteristics including age, sex, neurological history, body temperature on admission, and duration of convulsion were not significantly different. The rate of barbiturate coma therapy was not different between groups (fPHT:44%, cMDL:34%, p = 0.27). The rate of mechanical ventilation was not different between groups (fPHT:47%, cMDL:52%, p = 0.72). The full recovery of consciousness was more frequent in the group of fPHT than cMDL at both 6 hours (fPHT:36%, cMDL:18%, p = 0.03) and 12 hours (fPHT:47%, cMDL:28%, p = 0.04).
[Conclusions] This study suggested that fPHT showed less CNS depression than cMDL, and fPHT might be more useful than cMDL in pediatric FSE.
[Methodology] We included the consecutive patients who: 1) were admitted to the Kobe Children’s Hospital due to convulsion or impaired consciousness with fever, 2) were from 1 month to 15 years, 3) were injected with either fPHT or cMDL after benzodiazepine administration. We excluded patients given ≥2 second-line treatments including fPHT, cMDL, phenytoin, or phenobarbital. We assessed the induction of barbiturate coma therapy representing failure of fPHT or cMDL for efficacy, mechanical ventilation representing respiratory depression, and the level of consciousness at 6 hours and 12 hours after initial neurologic symptoms representing CNS depression.
[Results] The number of patients in fPHT and cMDL was 45 and 97, respectively. Characteristics including age, sex, neurological history, body temperature on admission, and duration of convulsion were not significantly different. The rate of barbiturate coma therapy was not different between groups (fPHT:44%, cMDL:34%, p = 0.27). The rate of mechanical ventilation was not different between groups (fPHT:47%, cMDL:52%, p = 0.72). The full recovery of consciousness was more frequent in the group of fPHT than cMDL at both 6 hours (fPHT:36%, cMDL:18%, p = 0.03) and 12 hours (fPHT:47%, cMDL:28%, p = 0.04).
[Conclusions] This study suggested that fPHT showed less CNS depression than cMDL, and fPHT might be more useful than cMDL in pediatric FSE.