We analyzed the first 81 children (44 males) with refractory convulsive status epilepticus (RCSE). The median (p25-p75) age at the episode was 3.6 years. The first, second, and third antiepileptic drug (AED) doses were administered at a median (p25–p75) time of 28 (6–67) minutes, 40 (20 – 85) minutes, and 59 (30 – 120) minutes after status epilepticus (SE) onset. Considering AED classes, the initial AED was a benzodiazepine in 78 (96.3%) patients and 2 (2 – 3) doses of benzodiazepines were administered before switching to non-benzodiazepine AEDs. The first and second doses of non-benzodiazepine AEDs were administered at 69 (40 – 120) minutes and 120 (75 – 296) minutes. In the 64 patients with out-of-hospital SE onset, 40 (62.5%) patients did not receive any AED before hospital arrival. In the hospital setting, the first and second in-hospital AED doses were given at 8 (5 – 15) minutes and 16 (10 – 40) minutes after SE onset (for patients with in-hospital SE onset) or after hospital arrival (for patients with out-of-hospital SE onset).
In summary, the time elapsed from SE onset to AED administration and escalation from one class of AED to another is delayed, both in the pre-hospital and in-hospital settings.