Introduction

Important contributions in developmental neurobiology have helped further the understanding of status epilepticus (SE) in childhood and infancy and provided the basis for neuroprotection in pediatric epilepsy (46). Over the past several years, numerous clinical trials have been undertaken on the treatment of SE in infants and children. Despite these efforts by the clinical and research community, the use of drugs to manage SE remains extremely variable among pediatric centers (22). Several consensus conferences organized around the treatment of pediatric SE seem to have worsened the situation, as is sometimes the case when a consensus is sought but the greater need is for more hard research.

The discussion in this chapter reflects the uncertainty regarding the management of pediatric SE. The precise chronology of events in children and the sequence of treatments are both complex, and treatments may vary according to local circumstances, which are difficult to take into account in multicenter studies. Yet these local circumstances may have crucial consequences for the prognosis of young children with seizures. The beneficial drug associations noted are based on reasonable hypotheses, not on well-controlled clinical trials. Further, there is a gray zone between undertreatment and overtreatment, the latter with its attendant risks of respiratory depression and hypotension. The ideal treatment is therefore difficult to delineate and is not satisfactorily approached with available data. This aspect of treatment becomes more complex when we consider that data obtained in adults are not necessarily applicable to children. There is the additional concern about developmental delay; long-term follow-up studies are needed to assess the results of treatments but are rarely performed. Although promising information about neural protection has been discovered by using animal models, the pharmacologic transfer of these results to epilepsy in humans awaits further investigation, and practical applications are still meager.