Abstract
Objective
Oral diazepam, administered in varying doses, is among the few proposed treatment
options for electrical status epilepticus during slow wave sleep in children. We sought
to retrospectively evaluate the long-term efficacy of high-dose oral diazepam in reducing
electrographic and clinical evidence of electrical status epilepticus during slow
wave sleep in children. Additionally, we surveyed caregivers to assess safety and
behavioral outcomes related to ongoing therapy.
Methods
We collected demographic and clinical data on children treated for electrical status
epilepticus during slow wave sleep between October 2010 and March 2013. We sought
to identify the number of patients who achieved at least a 50% reduction in spike
wave index on electroencephalograph after receiving high-dose oral diazepam. We also
administered a questionnaire to caregivers to assess for behavioral problems and side
effects.
Results
We identified 42 evaluable patients who received high-dose diazepam (range 0.23-2.02 mg/kg
per day) to treat electrical status epilepticus during slow wave sleep. Twenty-six
patients had spike reduction data and 18/26 (69.2%) children achieved a greater than
50% reduction in spike wave count from an average of 15.54 to 5.05 (P = 0.001). We received 28 responses to the questionnaire. Some patients experienced
new onset of difficulties with problem-solving and speech and writing development.
Sleep disturbances (50%) and irritability (57.1%) were the most frequent side effects
reported. There did not appear to be a dose-related effect with electroencephalograph
changes, behavioral effects, or side effects.
Conclusions
High-dose oral diazepam significantly reduces the spike wave count on electroencephalograph
in children with electrical status epilepticus during slow wave sleep. Although this
therapy improves electroencephalograph-related findings, it can be associated with
concerning neurological and behavioral side effects in some individuals, so further
study is warranted.
Keywords
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Article info
Publication history
Published online: November 13, 2013
Accepted:
November 5,
2013
Received:
September 11,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
