By: Jamie Morton

A breakthrough discovery could transform treatment for what is the most common neurological emergency in children seen by hospitals.

Severe epileptic seizures can be fatal: up to 5 per cent of affected children die, and a third suffer long-term complications from brain damage.

Crucially, the longer the seizure, the greater the chance of long-term complications.

In severe seizures, the first line of treatment – the medications benzodiazepines – only stops the seizures in 40 to 60 per cent of patients.

The second-line treatment has long been giving the anti-convulsant drug phenytoin, which was known to have some serious complications and – until now – had never been scrutinised in a randomised controlled trial.

In a just-published, world-leading study by New Zealand and Australian researchers, phenytoin was compared with the newer anti-convulsant levetiracetam for the second-line treatment of seizures.

Levetiracetam is used routinely as a daily medication to prevent seizures, but has not been properly tested against phenytoin for treatment of severe prolonged seizures.

The research, funded by the Health Research Council and carried out by the Predict research network in 13 emergency departments at hospitals here and in Australia, involved 233 child patients aged between three months and 16 years.

The researchers found that when given individually, the drugs were as good as each other: both had a moderate success rate of 50 to 60 per cent at stopping a prolonged seizure.

But strikingly, treatment with one drug and then the other increased the success rate of stopping a seizure to approximately 75 per cent.

Previously, children who continued having seizures after phenytoin then needed to be intubated, sedated and placed on a ventilator in intensive care.

By giving these two medications one after the other, researchers have potentially halved the number of children ventilated and sent to intensive care.

“This study has now given us robust evidence to manage children with prolonged seizures without reverting to intubation and intensive care,” said study leader Professor Stuart Dalziel, of the University of Auckland’s Faculty of Medical and Health Sciences.

“By controlling seizures in the emergency department we will increase the chance of these children recovering more quickly and returning back to their normal lives.”

Dalziel, who is a paediatric emergency medicine specialist at Auckland’s Starship Children’s Hospital, said the research has already changed practice and led to new guidelines on both sides of the Tasman.

Study co-author Professor Franz Babl, of the University of Melbourne and the Murdoch Children’s Research Institute, expected the study would “profoundly improve” treatment for children who were critically ill with epilepsy around the world.

EPILEPSY IN NEW ZEALAND

• The prevalence rate of epilepsy in New Zealand is around one per cent of the population – or 45,000 people.

• Incidence is highest under the age of 2 and over 65, and males are slightly more likely to develop epilepsy than females.

• 70 per cent of people with epilepsy can be expected to be seizure-free.

• In patients with complex drug-resistant epilepsy, sudden unexpected death may account for as much as 25 to 65 per cent of all deaths.

Source: Epilepsy New Zealand

Source: NZ Herald

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