Additional modalities for treating acute seizures in children: Overview

The pharmacologic interventions for treatment of acute repetitive seizures and those for treatment of status epilepticus are similar. The choice of treatment should be based on the drug's onset of action, spectrum of anticonvulsant activity, route and ease of administration, elimination half-life, therapeutic margin of safety, and redistribution from the central nervous system. Treatment should be initiated early in patients who are prone to seizure clusters or prolonged partial seizures that may generalize or progress to status epilepticus. Benzodiazepines have become first-line dugs for treatment of acute seizures and status epilepticus, followed by phenytoin/fosphenytoin and phenobarbital. Short-acting benzodiazepines, including diazepam, lorazepam, clonazepam, and midazolam, can decrease the frequency of emergency department visits if given at the appropriate times. The recently approved intravenous formulation of valproate may be of use in children receiving oral valproate who develop breakthrough seizures caused by subtherapeutic plasma levels that are secondary to missed doses or an inability to tolerate oral valproate.