Epilepsy guidelines urge doctors to treat patients faster

Guidelines still under development for the treatment of status epilepticus will suggest more rapid drug treatment of seizures in a pediatric setting, according to a presentation at the American Academy of Pediatrics (AAP) National Conference and Exhibition.James Riviello Jr., MD, Professor of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States, presented highlights of the guidelines here on October 10th.

The Epilepsy Foundation of American is updating its 1993 guidelines for the treatment of status epilepticus and the American Academy of Neurology and Child Neurology Society are working on guidelines for diagnostic assessment of children with the condition.Taken together, Dr. Riviello said the two sets of recommendations should shift clinical practice. "We're recommending treatment sooner," he said, "and we'll say that there's little evidence that any one [diagnostic] test needs to be done."

According to the 1993 guidelines, treatment with diazepam or lorazepam should be initiated if the seizures continue for 10 minutes; the new recommendations will push the threshold for drug treatment to 5 minutes, he said.The shortened interval between onset of seizure and medical treatment continues a decades-long trend of shortening the length of time needed to define and treat status epilepticus -- prolonged or repeated seizures that signify an enduring epileptic condition.In 1970, 1 hour of seizure was considered necessary to show evidence of status epilepticus.

By 1989, that duration was down to 30 minutes, dropping again in the 1990s to 10 minutes.Now, doctors are urged to move to phenytoin doctors after diazepam or lorazepam, then to Phenobarbital, Dr. Riviello said. He did not say, however, whether recommendations for treatment with those agents would be modified when the guidelines are published.

The diagnostic recommendations are likely to underscore the difficulty of relying on any one measure to assess seizures. Few tests are highly sensitive in detecting problems, and Dr. Riviello underscored the fact that no single test appeared to be definitive. Even magnetic resonance imaging, the most powerful and most expensive tool, only returns abnormal findings in 78% of cases, he said.