Efficacy and mortality in treatment of refractory generalized convulsive status epilepticus in children: A meta-analysis

There is no consensus on the choice of drug treatment for refractory genera lized convulsive status epilepticus in children. The objective of this meta -analysis of the published literature was to determine the effects of drug treatments on efficacy (seizure cessation) and mortality in children with t his condition, controlling for potential confounding factors. One hundred e leven children, treated with diazepam, midazolam, thiopental, pentobarbital , or isoflurane, met strict inclusion criteria. Diazepam was si,significant ly less efficacious than other treatments (P =.006) stratifying for etiolog y. Overall mortality was 20% in symptomatic cases and 4% in idiopathic case s (P =.038). Mortality was less frequent in midazolam-treated patients (P = .021) stratifying for etiology. Midazolam appears to be a good choice for i nitial treatment of refractory generalized convulsive status epilepticus in children, but the attribution of differences in efficacy and mortality sol ely to drug effect is not possible based on the published literature.