Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A

ilustraciones, diagramas

Autores:: Salas Muñoz, Diego Fernando

Tipo de recurso:

Fecha de publicación:: 2019

Institución:: Universidad Nacional de Colombia

Repositorio:: Universidad Nacional de Colombia

Idioma:: spa

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dc.title.spa.fl_str_mv	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A
dc.title.translated.eng.fl_str_mv	Description of the Use of Intravenous Clonazepam in a Pediatric Cohort with Status Epilepticus Type A
title	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A
spellingShingle	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A 610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría 610 - Medicina y salud::615 - Farmacología y terapéutica Farmacología Clonazepam Convulsiones Pharmacology Seizures Clonazepam Estado epiléptico Convulsión Niños Clonazepam Epileptic state Seizure Children
title_short	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A
title_full	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A
title_fullStr	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A
title_full_unstemmed	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A
title_sort	Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A
dc.creator.fl_str_mv	Salas Muñoz, Diego Fernando
dc.contributor.advisor.none.fl_str_mv	Izquierdo Bello, Álvaro Hernando
dc.contributor.author.none.fl_str_mv	Salas Muñoz, Diego Fernando
dc.contributor.educationalvalidator.none.fl_str_mv	Vásquez Hoyos, Pablo
dc.contributor.subjectmatterexpert.none.fl_str_mv	Valero Guzmán, Leonardo
dc.subject.ddc.spa.fl_str_mv	610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría 610 - Medicina y salud::615 - Farmacología y terapéutica
topic	610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría 610 - Medicina y salud::615 - Farmacología y terapéutica Farmacología Clonazepam Convulsiones Pharmacology Seizures Clonazepam Estado epiléptico Convulsión Niños Clonazepam Epileptic state Seizure Children
dc.subject.decs.spa.fl_str_mv	Farmacología Clonazepam Convulsiones
dc.subject.decs.eng.fl_str_mv	Pharmacology Seizures
dc.subject.proposal.spa.fl_str_mv	Clonazepam Estado epiléptico Convulsión Niños
dc.subject.proposal.eng.fl_str_mv	Clonazepam Epileptic state Seizure Children
description	ilustraciones, diagramas
publishDate	2019
dc.date.issued.none.fl_str_mv	2019
dc.date.accessioned.none.fl_str_mv	2024-01-31T21:20:46Z
dc.date.available.none.fl_str_mv	2024-01-31T21:20:46Z
dc.type.spa.fl_str_mv	Trabajo de grado - Especialidad Médica
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.content.spa.fl_str_mv	Text
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status_str	acceptedVersion
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dc.identifier.instname.spa.fl_str_mv	Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv	Repositorio Institucional Universidad Nacional de Colombia
dc.identifier.repourl.spa.fl_str_mv	https://repositorio.unal.edu.co/
url	https://repositorio.unal.edu.co/handle/unal/85579 https://repositorio.unal.edu.co/
identifier_str_mv	Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.references.spa.fl_str_mv	Willmore LJ. Epilepsy emergencies: the first seizure and status epilepticus. Neurology 1998; 51: S34-8. Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia 1999; 40: 120–2. Raspall-Chaure M, Chin RFM, Neville BG, Bedford H, Scott RC. The epidemiology of convulsive status epilepticus in children: A critical review. Epilepsia 2007; 48: 1652–1663. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S et al. A definition and classification of status epilepticus - Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56: 1515–1523. Trinka E, Brigo F, Shorvon S. Recent advances in status epilepticus. Curr Opin Neurol 2016; 29: 189–198. Uscátegui Daccarett AM, Ramírez Sierra CL, Farfán Albarracín JD. Fisiopatología del Estado Epiléptico. In: Uscátegui Daccarett AM, Morales Fonseca NI (eds). Orientación y manejo del estado epiléptico en niños. Universidad Nacional de Colombia, Facultad de Medicina: Bogotá D.C, 2018, pp 41–52. Prasad M, Krishnan PR, Sequeira R, Al-Roomi K. Anticonvulsant therapy for status epilepticus. In: Prasad M (ed). Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd: Chichester, UK, 2014 doi:10.1002/14651858.CD003723.pub3. Trinka E, Höfler J, Leitinger M, Brigo F. Pharmacotherapy for Status Epilepticus. Drugs 2015; 75: 1499–1521. Trinka E. Benzodiazepines used primarily for emergency treatment (diazepam, lorazepam, and midazolam). In: Shorvon SD, Perucca E, Engel Jr J, editors. Treatment of epilepsies. 3rd ed. Oxford: Blackwell Publishing; 2009. p. 470–84. . Friedman H, Ochs HR, Greenblatt DJ, Shader RI. Tissue distribution of diazepam and its metabolite desmethyldiazepam: a human autopsy study. J Clin Pharmacol; 25: 613–5. Ochs H, Busse J, Greenblatt D, Allen M. Entry of lorazepam into cerebrospinal fluid [letter]. Br J Clin Pharmacol 1980; 10: 405–406. Nishiyama T, Tamai H, Hanaoka K. Serum and cerebrospinal fluid concentrations of midazolam after epidural administration in dogs. Anesth Analg 2003; 96: 159–62, table of contents. Sjövall S, Kanto J, Himberg J-J, Hovi-Viander M, Salo M. CSF penetration and pharmacokinetics of midazolam. Eur J Clin Pharmacol 1983; 25: 247–251. Balk M, Hentschke H, Rudolph U, Antkowiak B, Drexler B. Differential depression of neuronal network activity by midazolam and its main metabolite 1-hydroxymidazolam in cultured neocortical slices. Sci Rep 2017; 7: 3503. Parry GJG. Concentration of Clonazepam in Serum and Cerebrospinal Fluid of the Sheep. Pharmacology 1977; 15: 318–323. Browne TR. Clonazepam. A review of a new anticonvulsant drug. Arch Neurol 1976; 33: 326–32. Griffin CE, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J 2013; 13: 214–23. Trinka E, Höfler J, Leitinger M, Rohracher A, Kalss G, Brigo F. Pharmacologic treatment of status epilepticus. Expert Opin Pharmacother 2016; 17: 513–534. McTague A, Martland T, Appleton R. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev 2018; 1: CD001905. Alvarez V, Lee JW, Drislane FW, Westover MB, Novy J, Dworetzky BA et al. Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: A multicenter comparison. Epilepsia 2015; 56: 1275–1285. Outin H. État de mal épileptique convulsif généralisé de l’adulte en situation d’urgence et en réanimation. Presse Med 2009; 38: 1823–1831. Clair B, Demeret S, Dupont S, Tazarourte K. Prise en charge de l’état de mal tonicoclonique généralisé : stratégies thérapeutiques. Rev Neurol (Paris) 2009; 165: 366–372. Debruyne D, Pailliet-Loilier M, Lelong-Boulouard V, Coquerel A, Bentué-Ferrer D, Suivi Thérapeutique Pharmacologique de la Société Française de Pharmacologie et de Thérapeutique. Suivi thérapeutique pharmacologique du clonazépam. Therapie 2010; 65: 219–224. Van Huffelen AC, Magnus O. De behandeling van de status epilepticus met clonazepam. Ned Tijdschr Geneeskd 1976; 120: 1734–8. Rantsch K, Walter U, Wittstock M, Benecke R, Rösche J. Treatment and course of different subtypes of status epilepticus. Epilepsy Res 2013; 107: 156–162. Forero Sanchez FA. Status epiléptico en niños, servicio de urgencias Hospital Universitario de la Misericordia: estudio descriptivo de 2 años con seguimiento a 6 meses e implementación de protocolo [tesis de grado]. Bogotá: Universidad Nacional de Colombia. 2007. Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia 2017; 58: 531–542. Gastaut H. Dictionary of epilepsy, part 1 definitions. Geneva: World Health Organization; 1973. . Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014; 55: 475–482. Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2009; 51: 1069–1077. Clark LP, Prout TP. Status epilepticus: a clinical and pathological study in epilepsy. Am J Psychiatry 1904; 60: 645-698–7. Commission on Terminology of the International League Against Epilepsy. A proposed international classification of epileptic seizures. Epilepsia 1964;5:297-306. Lowenstein DH. Status epilepticus: an overview of the clinical problem. Epilepsia 1999; 40 Suppl 1: S3-8; discussion S21-2. Furyk J, Ray R, Watt K, Dalziel SR, Oakely E, Mackay M et al. Consensus research priorities for paediatric status epilepticus: A Delphi study of health consumers, researchers and clinicians. Seizure 2018; 56: 104–109. Trinka E, Kälviäinen R. 25 Years of Advances in the Definition, Classification and Treatment of Status Epilepticus. Seizure 2017; 44: 65–73. Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001; 42: 1212–8. Berg AT, Millichap JJ. The 2010 Revised Classification of Seizures and Epilepsy. Contin Lifelong Learn Neurol 2013; 19: 571–597. Scheffer IE, French J, Hirsch E, Jain S, Mathern GW, Moshé SL et al. Classification of the epilepsies: New concepts for discussion and debate-Special report of the ILAE Classification Task Force of the Commission for Classification and Terminology. Epilepsia Open 2016; 1: 37–44. Shorvon S. What is nonconvulsive status epilepticus, and what are its subtypes? Epilepsia 2007; 48: 35–38. Koutroumanidis M. Comment on the recent ILAE special report on the definition and classification of status epilepticus. Epilepsia 2016; 57: 1199–1200. Bien CG, Elger CE. Epilepsia partialis continua: semiology and differential diagnoses. Epileptic Disord 2008; 10: 3–7 Kanazawa O, Sengoku A, Kawai I. Oculoclonic Status Epilepticus. Epilepsia 1989; 30: 121–123. Oono M, Uno H, Umesaki A, Nagatsuka K, Kinoshita M, Naritomi H. Severe and prolonged ictal paresis in an elderly patient. Epilepsy Behav case reports 2014; 2: 105–7. Uscátegui Daccarett AM, Morales Fonseca NI, Rozo Osorio JD, Patiño Moncayo ÁD. Etiología del Estado Epiléptico. In: Uscátegui Daccarett AM, Morales Fonseca NI (eds). Orientación y Manejo del Estado Epiléptico en Niños. Universidad Nacional de Colombia, Facultad de Medicina: Bogotá D.C, 2018, pp 33–39. Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K et al. Practice Parameter: Diagnostic assessment of the child with status epilepticus (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2006; 67: 1542–1550. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016; 16: 48–61. Uscátegui Daccarett AM, Rueda Rodríguez MC, Morales Fonseca NI. Tratamiento del Estado Epiléptico. In: Uscátegui Daccarett AM, Morales Fonseca NI (eds). Orientación y manejo del estado epiléptico en niños. Universidad Nacional de Colombia, Facultad de Medicina: Bogotá D.C, 2018, pp 117–138. Arayakarnkul P, Chomtho K. Treatment options in pediatric super-refractory status epilepticus. Brain Dev 2019; 41: 359–366. Shorvon S. Super-refractory status epilepticus: An approach to therapy in this difficult clinical situation. Epilepsia 2011; 52: 53–56. Riss J, Cloyd J, Gates J, Collins S. Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta Neurol Scand 2008; 118: 69–86. Betjemann JP, Josephson SA, Lowenstein DH, Guterman EL. Emergency Medical Services Protocols for Generalized Convulsive Status Epilepticus. JAMA 2019; 321: 1216. Sigel E, Ernst M. The Benzodiazepine Binding Sites of GABAA Receptors. Trends Pharmacol Sci 2018; 39: 659–671. Ochoa JG, Kilgo WA. The Role of Benzodiazepines in the Treatment of Epilepsy. Curr Treat Options Neurol 2016; 18: 18. Rylance GW, Poulton J, Cherry RC, Cullen RE. Plasma concentrations of clonazepam after single rectal administration. Arch Dis Child 1986; 61: 186–8. Nour SA, Abdelmalak NS, Naguib MJ, Rashed HM, Ibrahim AB. Intranasal brain-targeted clonazepam polymeric micelles for immediate control of status epilepticus: in vitro optimization, ex vivo determination of cytotoxicity, in vivo biodistribution and pharmacodynamics studies. Drug Deliv 2016; 23: 3681–3695. Troester MM, Hastriter E V., Ng Y-T. Dissolving Oral Clonazepam Wafers in the Acute Treatment of Prolonged Seizures. J Child Neurol 2010; 25: 1468–1472. Shangguan Y, Liao H, Wang X. Clonazepam in the treatment of status epilepticus. Expert Rev Neurother 2015; 15: 733–740. Singh AN, Le Morvan P. Treatment of status epilepticus with intravenous clonazepam. Prog Neuropsychopharmacol Biol Psychiatry 1982; 6: 539–42. Jensen PK, Abild K, Poulsen MN. Serum concentration of clonazepam after rectal administration. Acta Neurol Scand 1983; 68: 417–420. Crevoisier C, Delisle MC, Joseph I, Foletti G. Comparative single-dose pharmacokinetics of clonazepam following intravenous, intramuscular and oral administration to healthy volunteers. Eur Neurol 2003; 49: 173–7. Browne TR. Clonazepam: A review of a new anticonvulsant drug. Arch Neurol 1976; 33: 326–32. Treiman DM. Pharmacokinetics and clinical use of benzodiazepines in the management of status epilepticus. Epilepsia 1989; 30 Suppl 2: S4-10. Gastaut H, Courjon J, Poiré R, Weber M. Treatment of status epilepticus with a new benzodiazepine more active than diazepam. Epilepsia 1971; 12: 197–214. Congdon PJ, Forsythe WI. Intravenous Clonazepam in the Treatment of Status Epilepticus in Children. Epilepsia 1980; 21: 97–102. Sorel L, Mechler L, Harmant J. Comparative trial of intravenous lorazepam and clonazepam im status epilepticus. Clin Ther 1981; 4: 326–36. Navarro V, Dagron C, Elie C, Lamhaut L, Demeret S, Urien S et al. Prehospital treatment with levetiracetam plus clonazepam or placebo plus clonazepam in status epilepticus (SAMUKeppra): a randomised, double-blind, phase 3 trial. Lancet Neurol 2016; 15: 47–55. Lee JW. Fruitful Futility: What We Learned From a Failed Clinical Trial of Out-of-Hospital Status Epilepticus Trial. Epilepsy Curr 2016; 16: 147–9. Schomer AC, Kapur J. The SAMUKeppra study in prehospital status epilepticus: lessons for future study. Ann Transl Med 2016; 4: 468. Martin D, Hirt H. Clinical Experience with Clonazepam (Rivotril) in the Treatment of Epilepsies in Infancy and Childhood. Neuropediatrics 1973; 4: 245–266. Roussounis SH, de Rudolf N. Clonazepam in the treatment of children with intractable seizures. Dev Med Child Neurol 1977; 19: 326–34. Pinder RM, Brogden RN, Speight TM, Avery GS. Clonazepam: a review of its pharmacological properties and therapeutic efficacy in epilepsy. Drugs 1976; 12: 321–361. Dokkedal-Silva V, Berro LF, Galduróz JCF, Tufik S, Andersen ML. Clonazepam: Indications, Side Effects, and Potential for Nonmedical Use. Harv Rev Psychiatry 2019; : 1. Brigo F, Bragazzi NL, Bacigaluppi S, Nardone R, Trinka E. Is intravenous lorazepam really more effective and safe than intravenous diazepam as first-line treatment for convulsive status epilepticus? A systematic review with meta-analysis of randomized controlled trials. Epilepsy Behav 2016; 64: 29–36. Koubeissi M. Intravenous Clonazepam in Status Epilepticus. Epilepsy Curr 2016; 16: 89–90. Lee B, Asian Status Epilepticus Survey Group. Treatment gap for convulsive status epilepticus in resource-poor countries. Epilepsia 2018; 59: 135–139. DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996; 46: 1029–35. Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 2006; 368: 222–229. Mancuso CE, Tanzi MG, Gabay M. Paradoxical Reactions to Benzodiazepines: Literature Review and Treatment Options. Pharmacotherapy 2004; 24: 1177–1185. Tully I, Draper ES, Lamming CR, Mattison D, Thomas C, Martland T et al. Admissions to paediatric intensive care units (PICU) with refractory convulsive status epilepticus (RCSE): A two-year multi-centre study. Seizure 2015; 29: 153–161.
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dc.format.extent.spa.fl_str_mv	xv, 46 páginas
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dc.publisher.spa.fl_str_mv	Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv	Bogotá - Medicina - Especialidad en Pediatría
dc.publisher.faculty.spa.fl_str_mv	Facultad de Medicina
dc.publisher.place.spa.fl_str_mv	Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv	Universidad Nacional de Colombia - Sede Bogotá
institution	Universidad Nacional de Colombia
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spelling	Reconocimiento 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Izquierdo Bello, Álvaro Hernando405a7826c354aca39bc62b1f2e455879Salas Muñoz, Diego Fernando7d2dec9abcb8208205a674dcf5ed6590Vásquez Hoyos, PabloValero Guzmán, Leonardo2024-01-31T21:20:46Z2024-01-31T21:20:46Z2019https://repositorio.unal.edu.co/handle/unal/85579Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, diagramasINTRODUCCIÓN: El clonazepam (CZP) podría ser una opción de primera línea en el tratamiento del estado epiléptico (EE) por sus características farmacocinéticas y farmacodinámicas. Sin embargo, no existe investigación clínica que sustente su utilidad en pediatría, aunque su uso se ha extendido en algunas zonas de Europa y América Latina. Es necesario ampliar la investigación clínica en este campo. OBJETIVO: Describir la utilización del CZP endovenoso como medicamento de primera línea en el tratamiento del EE con síntomas motores prominentes en una cohorte de niños colombianos. MÉTODOS: Estudio observacional, descriptivo, retrospectivo. RESULTADOS: Se recolectaron 96 eventos (72 pacientes) con una mediana de edad de 4 años (RIQ 1.5-8). La mediana de estancia hospitalaria fue de 10.5 días (RIQ 7-20) de los cuales presentaron ingreso a unidades de cuidado critico el 47.92%. Se reportó Estado Epiléptico Refractario en el 6.25%. El 82.29% de los pacientes tenia antecedente de epilepsia. El 45.83% de la semiología del EE motor fue focal con evolución a bilateral Tónico-Clónico. En el 70.83% de los casos se resolvió el EE con solo administración de CZP IV con una dosis de 30.15 mcg/kg (RIQ 27.25 -33.3) con un control de crisis en un tiempo entre 1-10 minutos en el 68.75% de los casos. El efecto adverso más frecuente detectado fue el aumento de secreciones respiratorias en el 11.46%, seguido de insuficiencia ventilatoria aguda en el 7.29%, y choque en el 4.17%. CONCLUSIÓNES: En la población de estudio el control del EE motor con exclusivamente CZP IV fue de 70 % a una dosis de 30 mcg/kg. En el 68 % de los casos se logró control de crisis en los primeros 10 minutos. El efecto adverso más reportado fue el aumento de las secreciones respiratorias en el 11 %. Esperamos que otros grupos de investigación clínica tengan en cuenta nuestros resultados para realizar ensayos clínicos utilizando CZP IV en niños buscando disponer de diversas alternativas para el manejo del EE. (Texto tomado de la fuente)INTRODUCTION: Clonazepam (CZP) could be a first-line option in the treatment of epileptic status (EE) due to its pharmacokinetic and pharmacodynamic characteristics. However, there is no clinical research that supports its usefulness in pediatrics, although its use has been extended in some areas of Europe and Latin America. It is necessary to expand clinical research in this field. OBJECTIVE: To describe the use of intravenous CZP as a first-line medication in the treatment of EE with prominent motor symptoms in a cohort of Colombian children. METHODS: Observational, descriptive, retrospective study. RESULTS: 96 events (72 patients) were collected with a median age of 4 years (RIQ 1.5-8). The median hospital stay was 10.5 days (RIQ 7-20) of which 47.92% presented admission to critical care units. Refractory Epileptic Status was reported in 6.25%. 82.29% of the patients had a history of epilepsy. 45.83% of the semiology of the EE motor was focal with evolution to bilateral Tonic-Clonic. In 70.83% of the cases the EE was resolved with only administration of CZP IV with a dose of 30.15 mcg/kg (RIQ 27.25-33.3) with a crisis control in a time between 1-10 minutes in 68.75% of the cases. The most frequent adverse effect detected was the increase in respiratory secretions in 11.46%, followed by acute ventilatory insufficiency in 7.29%, and shock in 4.17%. CONCLUSIONS: In the study population, control of motor EE with exclusively CZP IV was 70% at a dose of 30 mcg/kg. In 68% of cases, crisis control was achieved in the first 10 minutes. The most reported adverse effect was the increase in respiratory secretions by 11%. We hope that other clinical research groups will take into account our results to conduct clinical trials using CZP IV in children seeking to have various alternatives for the management of EE.Especialidades MédicasEspecialista en Pediatríaxv, 46 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Especialidad en PediatríaFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::618 - Ginecología, obstetricia, pediatría, geriatría610 - Medicina y salud::615 - Farmacología y terapéuticaFarmacologíaClonazepamConvulsionesPharmacologySeizuresClonazepamEstado epilépticoConvulsiónNiñosClonazepamEpileptic stateSeizureChildrenDescripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo ADescription of the Use of Intravenous Clonazepam in a Pediatric Cohort with Status Epilepticus Type ATrabajo de grado - Especialidad Médicainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMWillmore LJ. Epilepsy emergencies: the first seizure and status epilepticus. Neurology 1998; 51: S34-8.Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia 1999; 40: 120–2.Raspall-Chaure M, Chin RFM, Neville BG, Bedford H, Scott RC. The epidemiology of convulsive status epilepticus in children: A critical review. Epilepsia 2007; 48: 1652–1663.Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S et al. A definition and classification of status epilepticus - Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56: 1515–1523.Trinka E, Brigo F, Shorvon S. Recent advances in status epilepticus. Curr Opin Neurol 2016; 29: 189–198.Uscátegui Daccarett AM, Ramírez Sierra CL, Farfán Albarracín JD. Fisiopatología del Estado Epiléptico. In: Uscátegui Daccarett AM, Morales Fonseca NI (eds). Orientación y manejo del estado epiléptico en niños. Universidad Nacional de Colombia, Facultad de Medicina: Bogotá D.C, 2018, pp 41–52.Prasad M, Krishnan PR, Sequeira R, Al-Roomi K. Anticonvulsant therapy for status epilepticus. In: Prasad M (ed). Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd: Chichester, UK, 2014 doi:10.1002/14651858.CD003723.pub3.Trinka E, Höfler J, Leitinger M, Brigo F. Pharmacotherapy for Status Epilepticus. Drugs 2015; 75: 1499–1521.Trinka E. Benzodiazepines used primarily for emergency treatment (diazepam, lorazepam, and midazolam). In: Shorvon SD, Perucca E, Engel Jr J, editors. Treatment of epilepsies. 3rd ed. Oxford: Blackwell Publishing; 2009. p. 470–84. .Friedman H, Ochs HR, Greenblatt DJ, Shader RI. Tissue distribution of diazepam and its metabolite desmethyldiazepam: a human autopsy study. J Clin Pharmacol; 25: 613–5.Ochs H, Busse J, Greenblatt D, Allen M. Entry of lorazepam into cerebrospinal fluid [letter]. Br J Clin Pharmacol 1980; 10: 405–406.Nishiyama T, Tamai H, Hanaoka K. Serum and cerebrospinal fluid concentrations of midazolam after epidural administration in dogs. Anesth Analg 2003; 96: 159–62, table of contents.Sjövall S, Kanto J, Himberg J-J, Hovi-Viander M, Salo M. CSF penetration and pharmacokinetics of midazolam. Eur J Clin Pharmacol 1983; 25: 247–251.Balk M, Hentschke H, Rudolph U, Antkowiak B, Drexler B. Differential depression of neuronal network activity by midazolam and its main metabolite 1-hydroxymidazolam in cultured neocortical slices. Sci Rep 2017; 7: 3503.Parry GJG. Concentration of Clonazepam in Serum and Cerebrospinal Fluid of the Sheep. Pharmacology 1977; 15: 318–323.Browne TR. Clonazepam. A review of a new anticonvulsant drug. Arch Neurol 1976; 33: 326–32.Griffin CE, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J 2013; 13: 214–23.Trinka E, Höfler J, Leitinger M, Rohracher A, Kalss G, Brigo F. Pharmacologic treatment of status epilepticus. Expert Opin Pharmacother 2016; 17: 513–534.McTague A, Martland T, Appleton R. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev 2018; 1: CD001905.Alvarez V, Lee JW, Drislane FW, Westover MB, Novy J, Dworetzky BA et al. Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: A multicenter comparison. Epilepsia 2015; 56: 1275–1285.Outin H. État de mal épileptique convulsif généralisé de l’adulte en situation d’urgence et en réanimation. Presse Med 2009; 38: 1823–1831.Clair B, Demeret S, Dupont S, Tazarourte K. Prise en charge de l’état de mal tonicoclonique généralisé : stratégies thérapeutiques. Rev Neurol (Paris) 2009; 165: 366–372.Debruyne D, Pailliet-Loilier M, Lelong-Boulouard V, Coquerel A, Bentué-Ferrer D, Suivi Thérapeutique Pharmacologique de la Société Française de Pharmacologie et de Thérapeutique. Suivi thérapeutique pharmacologique du clonazépam. Therapie 2010; 65: 219–224.Van Huffelen AC, Magnus O. De behandeling van de status epilepticus met clonazepam. Ned Tijdschr Geneeskd 1976; 120: 1734–8.Rantsch K, Walter U, Wittstock M, Benecke R, Rösche J. Treatment and course of different subtypes of status epilepticus. Epilepsy Res 2013; 107: 156–162.Forero Sanchez FA. Status epiléptico en niños, servicio de urgencias Hospital Universitario de la Misericordia: estudio descriptivo de 2 años con seguimiento a 6 meses e implementación de protocolo [tesis de grado]. Bogotá: Universidad Nacional de Colombia. 2007.Fisher RS, Cross JH, D’Souza C, French JA, Haut SR, Higurashi N et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia 2017; 58: 531–542.Gastaut H. Dictionary of epilepsy, part 1 definitions. Geneva: World Health Organization; 1973. .Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia 2014; 55: 475–482.Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G et al. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 2009; 51: 1069–1077.Clark LP, Prout TP. Status epilepticus: a clinical and pathological study in epilepsy. Am J Psychiatry 1904; 60: 645-698–7.Commission on Terminology of the International League Against Epilepsy. A proposed international classification of epileptic seizures. Epilepsia 1964;5:297-306.Lowenstein DH. Status epilepticus: an overview of the clinical problem. Epilepsia 1999; 40 Suppl 1: S3-8; discussion S21-2.Furyk J, Ray R, Watt K, Dalziel SR, Oakely E, Mackay M et al. Consensus research priorities for paediatric status epilepticus: A Delphi study of health consumers, researchers and clinicians. Seizure 2018; 56: 104–109.Trinka E, Kälviäinen R. 25 Years of Advances in the Definition, Classification and Treatment of Status Epilepticus. Seizure 2017; 44: 65–73.Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001; 42: 1212–8.Berg AT, Millichap JJ. The 2010 Revised Classification of Seizures and Epilepsy. Contin Lifelong Learn Neurol 2013; 19: 571–597.Scheffer IE, French J, Hirsch E, Jain S, Mathern GW, Moshé SL et al. Classification of the epilepsies: New concepts for discussion and debate-Special report of the ILAE Classification Task Force of the Commission for Classification and Terminology. Epilepsia Open 2016; 1: 37–44.Shorvon S. What is nonconvulsive status epilepticus, and what are its subtypes? Epilepsia 2007; 48: 35–38.Koutroumanidis M. Comment on the recent ILAE special report on the definition and classification of status epilepticus. Epilepsia 2016; 57: 1199–1200.Bien CG, Elger CE. Epilepsia partialis continua: semiology and differential diagnoses. Epileptic Disord 2008; 10: 3–7Kanazawa O, Sengoku A, Kawai I. Oculoclonic Status Epilepticus. Epilepsia 1989; 30: 121–123.Oono M, Uno H, Umesaki A, Nagatsuka K, Kinoshita M, Naritomi H. Severe and prolonged ictal paresis in an elderly patient. Epilepsy Behav case reports 2014; 2: 105–7.Uscátegui Daccarett AM, Morales Fonseca NI, Rozo Osorio JD, Patiño Moncayo ÁD. Etiología del Estado Epiléptico. In: Uscátegui Daccarett AM, Morales Fonseca NI (eds). Orientación y Manejo del Estado Epiléptico en Niños. Universidad Nacional de Colombia, Facultad de Medicina: Bogotá D.C, 2018, pp 33–39.Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K et al. Practice Parameter: Diagnostic assessment of the child with status epilepticus (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2006; 67: 1542–1550.Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016; 16: 48–61.Uscátegui Daccarett AM, Rueda Rodríguez MC, Morales Fonseca NI. Tratamiento del Estado Epiléptico. In: Uscátegui Daccarett AM, Morales Fonseca NI (eds). Orientación y manejo del estado epiléptico en niños. Universidad Nacional de Colombia, Facultad de Medicina: Bogotá D.C, 2018, pp 117–138.Arayakarnkul P, Chomtho K. Treatment options in pediatric super-refractory status epilepticus. Brain Dev 2019; 41: 359–366.Shorvon S. Super-refractory status epilepticus: An approach to therapy in this difficult clinical situation. Epilepsia 2011; 52: 53–56.Riss J, Cloyd J, Gates J, Collins S. Benzodiazepines in epilepsy: pharmacology and pharmacokinetics. Acta Neurol Scand 2008; 118: 69–86.Betjemann JP, Josephson SA, Lowenstein DH, Guterman EL. Emergency Medical Services Protocols for Generalized Convulsive Status Epilepticus. JAMA 2019; 321: 1216.Sigel E, Ernst M. The Benzodiazepine Binding Sites of GABAA Receptors. Trends Pharmacol Sci 2018; 39: 659–671.Ochoa JG, Kilgo WA. The Role of Benzodiazepines in the Treatment of Epilepsy. Curr Treat Options Neurol 2016; 18: 18.Rylance GW, Poulton J, Cherry RC, Cullen RE. Plasma concentrations of clonazepam after single rectal administration. Arch Dis Child 1986; 61: 186–8.Nour SA, Abdelmalak NS, Naguib MJ, Rashed HM, Ibrahim AB. Intranasal brain-targeted clonazepam polymeric micelles for immediate control of status epilepticus: in vitro optimization, ex vivo determination of cytotoxicity, in vivo biodistribution and pharmacodynamics studies. Drug Deliv 2016; 23: 3681–3695.Troester MM, Hastriter E V., Ng Y-T. Dissolving Oral Clonazepam Wafers in the Acute Treatment of Prolonged Seizures. J Child Neurol 2010; 25: 1468–1472.Shangguan Y, Liao H, Wang X. Clonazepam in the treatment of status epilepticus. Expert Rev Neurother 2015; 15: 733–740.Singh AN, Le Morvan P. Treatment of status epilepticus with intravenous clonazepam. Prog Neuropsychopharmacol Biol Psychiatry 1982; 6: 539–42.Jensen PK, Abild K, Poulsen MN. Serum concentration of clonazepam after rectal administration. Acta Neurol Scand 1983; 68: 417–420.Crevoisier C, Delisle MC, Joseph I, Foletti G. Comparative single-dose pharmacokinetics of clonazepam following intravenous, intramuscular and oral administration to healthy volunteers. Eur Neurol 2003; 49: 173–7.Browne TR. Clonazepam: A review of a new anticonvulsant drug. Arch Neurol 1976; 33: 326–32.Treiman DM. Pharmacokinetics and clinical use of benzodiazepines in the management of status epilepticus. Epilepsia 1989; 30 Suppl 2: S4-10.Gastaut H, Courjon J, Poiré R, Weber M. Treatment of status epilepticus with a new benzodiazepine more active than diazepam. Epilepsia 1971; 12: 197–214.Congdon PJ, Forsythe WI. Intravenous Clonazepam in the Treatment of Status Epilepticus in Children. Epilepsia 1980; 21: 97–102.Sorel L, Mechler L, Harmant J. Comparative trial of intravenous lorazepam and clonazepam im status epilepticus. Clin Ther 1981; 4: 326–36.Navarro V, Dagron C, Elie C, Lamhaut L, Demeret S, Urien S et al. Prehospital treatment with levetiracetam plus clonazepam or placebo plus clonazepam in status epilepticus (SAMUKeppra): a randomised, double-blind, phase 3 trial. Lancet Neurol 2016; 15: 47–55.Lee JW. Fruitful Futility: What We Learned From a Failed Clinical Trial of Out-of-Hospital Status Epilepticus Trial. Epilepsy Curr 2016; 16: 147–9.Schomer AC, Kapur J. The SAMUKeppra study in prehospital status epilepticus: lessons for future study. Ann Transl Med 2016; 4: 468.Martin D, Hirt H. Clinical Experience with Clonazepam (Rivotril) in the Treatment of Epilepsies in Infancy and Childhood. Neuropediatrics 1973; 4: 245–266.Roussounis SH, de Rudolf N. Clonazepam in the treatment of children with intractable seizures. Dev Med Child Neurol 1977; 19: 326–34.Pinder RM, Brogden RN, Speight TM, Avery GS. Clonazepam: a review of its pharmacological properties and therapeutic efficacy in epilepsy. Drugs 1976; 12: 321–361.Dokkedal-Silva V, Berro LF, Galduróz JCF, Tufik S, Andersen ML. Clonazepam: Indications, Side Effects, and Potential for Nonmedical Use. Harv Rev Psychiatry 2019; : 1.Brigo F, Bragazzi NL, Bacigaluppi S, Nardone R, Trinka E. Is intravenous lorazepam really more effective and safe than intravenous diazepam as first-line treatment for convulsive status epilepticus? A systematic review with meta-analysis of randomized controlled trials. Epilepsy Behav 2016; 64: 29–36.Koubeissi M. Intravenous Clonazepam in Status Epilepticus. Epilepsy Curr 2016; 16: 89–90.Lee B, Asian Status Epilepticus Survey Group. Treatment gap for convulsive status epilepticus in resource-poor countries. Epilepsia 2018; 59: 135–139.DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996; 46: 1029–35.Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet 2006; 368: 222–229.Mancuso CE, Tanzi MG, Gabay M. Paradoxical Reactions to Benzodiazepines: Literature Review and Treatment Options. Pharmacotherapy 2004; 24: 1177–1185.Tully I, Draper ES, Lamming CR, Mattison D, Thomas C, Martland T et al. Admissions to paediatric intensive care units (PICU) with refractory convulsive status epilepticus (RCSE): A two-year multi-centre study. Seizure 2015; 29: 153–161.Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo APúblico generalLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/85579/3/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD53ORIGINAL1016044029.2019..pdf1016044029.2019..pdfEspecialidad Médica en Pediatríaapplication/pdf638513https://repositorio.unal.edu.co/bitstream/unal/85579/4/1016044029.2019..pdfca6aa5fc1cdb00c1766cc862ffb92ab6MD54THUMBNAIL1016044029.2019..pdf.jpg1016044029.2019..pdf.jpgGenerated Thumbnailimage/jpeg4476https://repositorio.unal.edu.co/bitstream/unal/85579/5/1016044029.2019..pdf.jpgbdde1bf62a3fbaae7cb1c4e379d04001MD55unal/85579oai:repositorio.unal.edu.co:unal/855792024-08-22 23:10:24.087Repositorio Institucional Universidad Nacional de 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Descripción del Uso de Clonazepam Endovenoso en una Cohorte Pediátrica con Estado Epiléptico Tipo A

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