Efficacy of intravenous clonazepam for paediatric convulsive status epilepticus

• Published in: Developmental medicine and child neurology 2024-08, Vol.66 (8), p.1053-1061
• Main Authors: Colmard, Maxime, Rivier, François, Barry, Gaëlle, Roubertie, Agathe, Urtiaga‐Valle, Sarai, Mercedes‐Alvarez, Blanca, Combes, Clementine, Cambonie, Gilles, Milesi, Christophe, Meyer, Pierre
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Anticonvulsants - administration & dosage; Child; Child, Preschool; Clonazepam - administration & dosage; Dose-Response Relationship, Drug; Female; Humans; Infant; Life Sciences; Male; Retrospective Studies; Status Epilepticus - drug therapy; Treatment Outcome
• ISSN: 0012-1622; 1469-8749; 1469-8749
• DOI: 10.1111/dmcn.15859

Aim To compare the efficacy of intravenous clonazepam (CLZ) for the initial management of convulsive status epilepticus (CSE) in children as a function of the first‐line in‐hospital dose used. Method This monocentric retrospective study included children who received a first dose of CLZ for CSE at Montpellier University Hospital, France, between January 2016 and June 2019. Data from medical records (clinical, treatment, course) were collected and compared as a function of the first CLZ dose used. Results Among the 310 children treated for CSE, 105 received at least one CLZ dose (median age 3 years; quartile 1–quartile 3 [Q1–Q3] = 1 years 2 months–6 years 6 months). Among these 105 patients, 24 (22%) received a dose less than 0.03 mg/kg (low dose) and 69 (65%) received a dose of at least 0.03 mg/kg (high dose). Seizure cessation rate was not different between the low‐ and high‐dose groups (62.5% vs 76%; odds ratio 0.53, 95% confidence interval [CI] 0.19–1.44, p = 0.29). The administration of a second dose of CLZ was more frequent in the low‐ than the high‐dose group (37.5% vs 16%; odds ratio 3.2, 95% CI 1.1–9.1, p = 0.04). Interpretation Our study did not find any difference in seizure termination rate as a function of CLZ dose in children with CSE. However, a second CLZ dose was more frequently needed in the group receiving low (less than 0.03 mg/kg) CLZ. This original article is commented by Mifsud on pages 968–969 of this issue.