Scott, Rodney Craig; (1999) Childhood status epilepticus: Structural consequences and assessment of a novel treatment. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

Status epilepticus (SE) is the commonest medical neurological emergency in childhood. In animal models of SE, the hippocampus is frequently damaged. The histological features resemble mesial temporal sclerosis (MTS), the commonest pathology in temporal lobe resections in adult humans. The commonest association with MTS is prolonged febrile convulsion (PFC). Hippocampal damage only occurs if seizures persist for at least 30 minutes. Early termination of seizures may decrease the incidence of MTS. Treatment with rectal diazepam is not always acceptable. An effective, convenient and acceptable method of treating SE would be advantageous. To address the question of whether MTS has different magnetic resonance (MR) characteristics dependent on antecedent, quantitative MR data from patients with histologically proven MTS was reviewed. Patients with a history of PFC have asymmetrical hippocampal volume (HCV) and T2 relaxation time (T2) when compared to patients with no history of PFC and controls. This may suggest that severity and extent of MTS may be, in part, determined by the cause. The assessment of whether SE results in acute brain abnormalities was carried out by prospectively investigating children using MR techniques. Within 48 hours of PFC there is an increase in HCV and T2 relaxation time when compared to controls. Patients with SE and no fever have an increased T2 relaxation time but normal hippocampal volume. PFC appears to result in acute hippocampal swelling, consistent with animal model data. The effect of non-febrile SE on limbic structures is less certain. Buccal midazolam was assessed as an effective, socially acceptable acute treatment for seizures. A pharmacokinetic/pharmacodynamic study confirmed rapid absorption into venous blood and brain. Buccal midazolam was shown to be an effective treatment for acute repetitive seizures and at least as effective as rectal diazepam in the treatment of seizures which have persisted for longer than 5 minutes.

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