Supplementary Material for: Management of status epilepticus by different pediatric departments: neurology, intensive care and emergency medicine

Introduction: The aim of this study was to explore the differences in status epilepticus (SE) management among pediatric neurology, emergency medicine and intensive care specialists in Turkey. Methods: A 22-item questionnaire regarding first, second and third-line management strategies of SE including demographic characteristics and common etiologies according to speciality of participants was mailed to 370 specialists working in Turkey. Results: A total of 334 participants (response rate 90%); with 136 pediatric neurologists, 102 pediatric emergency medicine and 96 pediatric intensive care specialists completed the survey. While intensive care specialists frequently managed SE due to metabolic and autoimmune reasons; the most common etiologies encountered by emergency medicine specialists were epilepsy and infections. More than half of intensive care specialists (64.6%) reported using non-BDZ antiseizure medications in the 5th minute of the seizure. Most of neurologists (76.4%) preferred to administer intravenous (iv) levetiracetam infusion as a second line agent. About half of intensive care specialists and neurologists tried immunomodulatory therapies in super refractory SE. Intensive care and emergency medicine specialists were less likely to favor ketogenic diet and pyridoxine therapy for the treatment of super refractory SE. The rate of requesting EEG monitoring to recognize nonconvulsive SE was found to be very low except for neurologists. Conclusion: There was no consensus among neurologists, intensive care and emergency medicine specialists in the management of SE in Turkey. Familiarity with particular antiseizure medications and the etiologies they manage seem to be the most important factors influencing the attitudes.

引言：本研究旨在探讨土耳其儿科神经科、急诊科与重症医学科专科医师在癫痫持续状态（status epilepticus, SE）诊疗实践中的差异。
方法：本研究向土耳其境内370名专科医师邮寄了一份包含22个条目的问卷，内容涵盖癫痫持续状态的一线、二线及三线诊疗策略，同时收集了参与者的人口统计学特征及与其所在专科相关的常见病因信息。
结果：最终共有334名参与者完成问卷，有效回收率为90%；其中包括136名儿科神经科医师、102名儿科急诊科医师与96名儿科重症医学科专科医师。重症医学科专科医师更常接诊因代谢性与自身免疫性病因引发的癫痫持续状态；而急诊科专科医师最常遇到的癫痫持续状态病因为癫痫本身与感染性疾病。超过半数（64.6%）的重症医学科专科医师表示，会在癫痫发作第5分钟时使用非苯二氮䓬类抗癫痫药物。76.4%的儿科神经科医师首选将静脉输注左乙拉西坦（levetiracetam）作为二线治疗药物。约半数重症医学科专科医师与神经科医师会在超难治性癫痫持续状态（super refractory SE）中尝试免疫调节治疗。重症医学科与急诊科专科医师较不倾向于采用生酮饮食与吡哆醇治疗超难治性癫痫持续状态。除神经科医师外，其余专科医师申请脑电图（electroencephalography, EEG）监测以识别非惊厥性癫痫持续状态（nonconvulsive SE）的比例极低。
结论：土耳其的儿科神经科、重症医学科与急诊科专科医师在癫痫持续状态的诊疗实践中尚未达成共识。对特定抗癫痫药物及其对应诊疗病因的熟悉程度，似乎是影响其诊疗态度的最关键因素。