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ambos os pontos temporais &#40;t<span class="elsevierStyleInf">1</span> aos 5 minutos e t<span class="elsevierStyleInf">2</span> aos 30 minutos&#41; t&#234;m como base experimentos animais e pesquisa cl&#237;nica&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Assim&#44; em crian&#231;as&#44; h&#225; dois subgrupos de pacientes que apresentam convuls&#227;o&#58; aqueles com epis&#243;dios breves com dura&#231;&#227;o &#60; 5 minutos &#40;antes do t<span class="elsevierStyleInf">1</span>&#41; com alta probabilidade de resolu&#231;&#227;o sem tratamento&#59; e aqueles com epis&#243;dios com dura&#231;&#227;o &#62; 7 minutos&#44; mais propensos a evoluir para epis&#243;dios prolongados com necessidade de tratamento agudo para parar a convuls&#227;o&#46; O consenso da for&#231;a&#8208;tarefa da <span class="elsevierStyleItalic">Liga Internacional contra a Epilepsia</span> &#40;ILAE&#41; a respeito da classifica&#231;&#227;o do EME &#233; que o tratamento de crises convulsivas deve&#44; para tanto&#44; ser iniciado aproximadamente aos cinco minutos&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Este artigo discute algumas das quest&#245;es relacionadas ao tratamento anticonvulsivo de emerg&#234;ncia de convuls&#245;es agudas&#44; prolongadas e EME em crian&#231;as com &#234;nfase nas diretrizes e protocolos relacionados ao per&#237;odo pr&#233;&#8208;hospitalar&#44; aos servi&#231;os de emerg&#234;ncia m&#233;dica &#40;SEM&#41; e ao departamento de emerg&#234;ncia &#40;DE&#41; usados por sociedades&#44; organiza&#231;&#245;es e autoridades nacionais e regionais&#46; O leitor interessado em outro tipo de manejo&#44; investiga&#231;&#245;es e acompanhamento cl&#237;nico subsequente no departamento ambulatorial ou pelo m&#233;dico de aten&#231;&#227;o prim&#225;ria &#224; sa&#250;de deve buscar an&#225;lises de pr&#225;ticas recentes e as recomenda&#231;&#245;es da Academia Americana de Neurologia&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Fonte de dados</span><p id="par0020" class="elsevierStylePara elsevierViewall">Foi feita uma an&#225;lise sistem&#225;tica de artigos dispon&#237;veis nos bancos de dados do Pubmed e do Google Acad&#234;mico&#46; Listas de refer&#234;ncia de artigos identificados tamb&#233;m foram verificadas&#46; A estrat&#233;gia de busca incluiu a combina&#231;&#227;o das seguintes palavras&#8208;chave em ingl&#234;s&#58; estado de mal epil&#233;ptico&#44; convuls&#227;o prolongada&#44; tratamento e diretriz&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Crit&#233;rios de sele&#231;&#227;o</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nesta an&#225;lise qualitativa&#44; selecionamos artigos para considera&#231;&#227;o com o uso da declara&#231;&#227;o de 2009 do grupo de Itens de Relat&#243;rio Preferidos para An&#225;lises Sistem&#225;ticas e Metan&#225;lise &#40;Prisma&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> Os artigos publicados foram inclu&#237;dos em nossa an&#225;lise quando atendiam aos seguintes crit&#233;rios&#58; 1&#41; Protocolo ou diretriz sobre o uso de tratamento com medicamentos anticonvulsivos para convuls&#227;o prolongada ou EME publicados de 1&#176; de janeiro de 2000 a 28 de fevereiro de 2017&#59; 2&#41; Publica&#231;&#227;o que incluiu uma diretriz nacional ou regional para a popula&#231;&#227;o pedi&#225;trica no ambiente de SEM ou DE&#59; e 3&#41; nos casos em que mais de um artigo da mesma organiza&#231;&#227;o ou sociedade foi identificado&#44; inclu&#237;mos a publica&#231;&#227;o mais recente&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Todos os artigos que atenderam aos crit&#233;rios de inclus&#227;o foram submetidos &#224; extra&#231;&#227;o de dados e &#224; avalia&#231;&#227;o cr&#237;tica de cada autor&#46; As principais caracter&#237;sticas foram resumidas ap&#243;s a extra&#231;&#227;o de dados&#44; consistiram em&#58; autoria&#59; per&#237;odo de manejo&#44; SEM ou DE&#59; per&#237;odo do tratamento&#59; e medica&#231;&#227;o recomendada e via de administra&#231;&#227;o&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">S&#237;ntese&#47;an&#225;lise de dados</span><p id="par0035" class="elsevierStylePara elsevierViewall">A estrat&#233;gia de busca dos bancos de dados identificou 356 t&#237;tulos listados&#46; Cada resumo foi examinado e 344 foram exclu&#237;dos porque n&#227;o atendiam aos crit&#233;rios de inclus&#227;o&#46; Doze artigos foram eleg&#237;veis para an&#225;lise completa e suas listas de refer&#234;ncia identificaram mais um artigo&#46; Assim&#44; 13 artigos foram inclu&#237;dos na s&#237;ntese qualitativa e os achados foram analisados descritivamente<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;17</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados e discuss&#227;o</span><p id="par0040" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a> descreve as caracter&#237;sticas das diretrizes de tratamento&#46; A <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a> apresenta o uso de medicamentos anticonvulsivos imediatos &#40;&#8220;STAT&#8221; ou <span class="elsevierStyleItalic">statim</span> &#91;Latim&#93;&#41; por tipo&#44; dosagem e via de administra&#231;&#227;o abordados nas diretrizes&#46; &#201; evidente que as diretrizes n&#227;o recomendam exatamente a mesma dosagem para cada medicamento anticonvulsivo&#46; Contudo&#44; essas diferen&#231;as poder&#227;o ser devidas a prefer&#234;ncias regionais&#44; hist&#243;rico ou experi&#234;ncia&#46; Os desenvolvedores de novas diretrizes devem levar em considera&#231;&#227;o a dosagem e a dosagem m&#225;xima recomendada&#44; bem como quaisquer novos estudos cl&#237;nicos sobre medicamentos publicados ap&#243;s 2017&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Manejo pr&#233;&#8208;hospitalar</span><p id="par0045" class="elsevierStylePara elsevierViewall">Seis diretrizes tiveram como foco o manejo nos SEM&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10&#8211;14</span></a> Na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#44; selecionamos o algoritmo pelos Servi&#231;os de Emerg&#234;ncia M&#233;dica para Crian&#231;as &#40;SEMC&#41; para compara&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Essa diretriz foi aplicada a crian&#231;as com convuls&#227;o testemunhada n&#227;o relacionada a trauma e que ainda ocorressem no momento da chegada ao SEM&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">No geral&#44; todas as seis diretrizes recomendaram midazolam bucal ou midazolam intranasal e tr&#234;s recomendaram midazolam intramuscular&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11&#44;14</span></a> Cinco diretrizes recomendaram diazepam retal como op&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10&#44;12&#8211;14</span></a> Uma segunda dose de benzodiazepina foi recomendada em duas das diretrizes&#44; uma aos cinco minutos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> e outra aos 10&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> Todas as diretrizes declararam prefer&#234;ncia por vias de administra&#231;&#227;o n&#227;o intravenosas opcionais em vez de acesso intravenoso na chegada&#46; Duas das diretrizes<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;13</span></a> recomendaram tentar o acesso intravenoso ou intra&#243;sseo em situa&#231;&#245;es espec&#237;ficas&#46; Por fim&#44; apenas uma das diretrizes forneceu crit&#233;rios para transfer&#234;ncia do paciente para o DE&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Coment&#225;rio sobre diretrizes de SEM pr&#233;&#8208;hospitalares</span><p id="par0055" class="elsevierStylePara elsevierViewall">Ao considerar as seis diretrizes pr&#233;&#8208;hospitalares&#44; o midazolam via bucal ou intranasal foi recomendado por todas elas&#46; Essa diretriz provavelmente reflete a efic&#225;cia do midazolam em compara&#231;&#227;o com o diazepam e a facilidade de administra&#231;&#227;o por essas vias de acesso&#46; Contudo&#44; o diazepam retal ainda aparecia na maioria das diretrizes pr&#233;&#8208;hospitalares&#46; O midazolam bucal &#233; mais efetivo do que o diazepam retal para interromper convuls&#245;es e reduzir sua recorr&#234;ncia em at&#233; uma hora de acometimento e t&#227;o seguro quanto o diazepam retal com rela&#231;&#227;o &#224; incid&#234;ncia de depress&#227;o respirat&#243;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> A efic&#225;cia do midazolam intranasal &#233; semelhante ou mais efetiva do que o diazepam retal&#46; O midazolam intranasal tamb&#233;m tem um tempo de administra&#231;&#227;o mais curto e uma a&#231;&#227;o mais r&#225;pida para interromper a convuls&#227;o do que o diazepam retal&#46; O midazolam intranasal &#233; de f&#225;cil administra&#231;&#227;o&#44; por&#233;m tem um breve efeito nasal irritante&#46; A an&#225;lise sistem&#225;tica mostra que o midazolam&#44; por qualquer via&#44; &#233; melhor para interromper a convuls&#227;o do que o diazepam&#44; por qualquer via&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Al&#233;m da efic&#225;cia e f&#225;cil administra&#231;&#227;o&#44; a benzodiazepina n&#227;o intravenosa depende da disponibilidade&#44; da experi&#234;ncia e da prefer&#234;ncia do local&#46; Por exemplo&#44; de acordo com Osborne et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> as ambul&#226;ncias no Reino Unido n&#227;o dispunham de midazolam&#44; ent&#227;o a equipe de SEM administraria o midazolam bucal ou intranasal do pr&#243;prio paciente&#44; caso dispon&#237;vel&#44; do contr&#225;rio&#44; o diazepam retal seria usado devido &#224; dificuldade do acesso intravenoso em crian&#231;as&#46; Por raz&#245;es semelhantes&#44; o diazepam retal normalmente estava dispon&#237;vel e foi recomendado na diretriz pr&#233;&#8208;hospitalar da Liga Italiana contra Epilepsia&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> A diretriz<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> da avalia&#231;&#227;o de triagem e tratamento de emerg&#234;ncia &#40;ETAT&#41; da Organiza&#231;&#227;o Mundial de Sa&#250;de &#40;OMS&#41; recomenda que quando as prepara&#231;&#245;es oral e intranasal do midazolam e do lorazepam n&#227;o estiverem prontamente dispon&#237;veis&#44; especialmente em ambientes com recursos limitados&#44; as prepara&#231;&#245;es intravenosas dispon&#237;veis podem ser administradas pelas vias oral ou intranasal&#46; Por fim&#44; o midazolam intramuscular foi recomendado em tr&#234;s das seis diretrizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11&#44;14</span></a> Essa administra&#231;&#227;o exige experi&#234;ncia adicional&#44; &#233; efetiva e segura&#46; Por exemplo&#44; no Teste de Medica&#231;&#227;o Anticonvulsiva R&#225;pida Antes da Chegada &#40;Rampart&#41;&#44; o midazolam intramuscular foi t&#227;o efetivo quanto o lorazepam intravenoso no ambiente pr&#233;&#8208;hospitalar&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Houve taxas semelhantes de intuba&#231;&#227;o endotraqueal e recorr&#234;ncia de convuls&#245;es nos grupos do midazolam e do lorazepam&#46; No geral&#44; todas as diretrizes recomendaram a via de administra&#231;&#227;o n&#227;o intravenosa&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Duas das diretrizes recomendaram tentar o acesso intravenoso ou intra&#243;sseo apenas em situa&#231;&#245;es espec&#237;ficas&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;13</span></a> O algoritmo pelos SEMC<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> nos Estados Unidos considera obter acesso intravenoso ou intra&#243;sseo quando o tempo de transporte esperado for longo ou quando exigido para outros aspectos do cuidado do paciente&#44; como fluido intravenoso ou outros medicamentos&#46; O algoritmo<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> pelo <span class="elsevierStyleItalic">Joint Royal Colleges Ambulance Liaison Committee</span> &#40;JRCALC&#41; do Reino Unido recomenda uma segunda dose de diazepam caso a convuls&#227;o continue ap&#243;s o diazepam retal&#44; deve ser administrada por via intravenosa ou intra&#243;ssea&#46; Contudo&#44; conseguir acesso intravenoso pode ser dif&#237;cil em uma crian&#231;a com convuls&#227;o cont&#237;nua no ambiente pr&#233;&#8208;hospitalar&#46; Isso exige prestadores de SEM treinados e equipamentos que poder&#227;o n&#227;o ser encontrados em ambientes com recursos limitados &#40;consulte a diretriz da ETAT<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#41;&#46; Al&#233;m disso&#44; a convuls&#227;o poder&#225; parar antes de obter acesso intravenoso&#44; tornar o procedimento desnecess&#225;rio&#59;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> o tempo necess&#225;rio para obter acesso intravenoso poder&#225; prolongar o tempo na cena e atrasar a administra&#231;&#227;o de medicamentos&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Duas das diretrizes recomendaram administrar uma segunda dose de benzodiazepinas no ambiente pr&#233;&#8208;hospitalar&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;13</span></a> As outras quatro diretrizes n&#227;o inclu&#237;ram essa op&#231;&#227;o&#46; Recomenda&#8208;se manter as vias a&#233;reas&#44; a respira&#231;&#227;o e a circula&#231;&#227;o adequadas enquanto o paciente &#233; transferido para o DE&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10&#44;12&#44;13</span></a> bem como entrar em contato com o centro de controle m&#233;dico para obter orienta&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Uma diretriz forneceu orienta&#231;&#227;o sobre crit&#233;rios para transfer&#234;ncia para o hospital&#46; A diretriz<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> do JRCALC recomenda a transfer&#234;ncia para o hospital em casos de crian&#231;as com menos de um ano&#44; crian&#231;as em sua primeira convuls&#227;o ou primeira convuls&#227;o febril e casos de convuls&#245;es sucessivas ou dificuldade de monitoramento&#46; A diretriz<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> do JRCALC tamb&#233;m recomenda uma transfer&#234;ncia de tempo cr&#237;tico para o hospital caso quaisquer dos seguintes sinais sejam observados&#58; dificuldade com problemas nas vias a&#233;reas&#44; na respira&#231;&#227;o&#44; na circula&#231;&#227;o ou de defici&#234;ncia&#59; les&#227;o s&#233;ria na cabe&#231;a&#59; EME ap&#243;s falha no tratamento&#59; ou infec&#231;&#227;o subjacente&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Manejo no departamento de emerg&#234;ncia</span><p id="par0075" class="elsevierStylePara elsevierViewall">Onze diretrizes tiveram como foco o manejo no DE&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;10&#44;12&#44;14&#8211;17</span></a> Para compara&#231;&#227;o&#44; selecionamos o algoritmo da Sociedade Americana de Epilepsia &#40;AES&#41; com rela&#231;&#227;o &#224; crise convulsiva com dura&#231;&#227;o de pelo menos cinco minutos&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> A estrutura desse algoritmo segue tr&#234;s fases de terapia &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">figuras 2&#8211;4</a> e <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; A primeira fase de terapia &#233; a estabiliza&#231;&#227;o inicial e a administra&#231;&#227;o de uma benzodiazepina&#46; A segunda fase de terapia &#233; a administra&#231;&#227;o de um segundo medicamento anticonvulsivo que n&#227;o seja a benzodiazepina em caso de falha das benzodiazepinas&#46; A terceira fase de terapia &#233; a administra&#231;&#227;o de um anest&#233;sico geral no apoio de terapia intensiva quando o EME se tornar resistente a pelo menos dois medicamentos anticonvulsivos da primeira e da segunda fases da terapia&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">O momento para iniciar cada fase de terapia foi semelhante em todas as diretrizes&#46; Na fase inicial de terapia&#44; nove das diretrizes relataram um momento de in&#237;cio igual ou anterior ao algoritmo da AES&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;7&#44;9&#44;10&#44;12&#44;15&#8211;17</span></a> O acometimento da segunda e da terceira fase de terapia foi igual ou anterior ao momento de in&#237;cio relatado pela AES em cinco das diretrizes que determinaram o momento de in&#237;cio&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;7&#44;12&#44;15</span></a> A intuba&#231;&#227;o endotraqueal foi considerada na fase de estabiliza&#231;&#227;o em duas das diretrizes<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;15</span></a> e no contexto de intuba&#231;&#227;o de sequ&#234;ncia r&#225;pida em quatro das diretrizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;7&#44;9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">No que diz respeito &#224; via de administra&#231;&#227;o de medicamentos anticonvulsivos&#44; o acesso intravenoso poder&#225; ser obtido ap&#243;s o est&#225;gio de terapia pr&#233;&#8208;hospitalar &#40;<a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#41;&#46; Quando n&#227;o houver acesso intravenoso no in&#237;cio do est&#225;gio de tratamento no DE&#44; as diretrizes recomendam acesso intra&#243;sseo na fase de tratamento inicial &#40;n &#61; 1&#41;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> ou secund&#225;ria &#40;n &#61; 2&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;7</span></a> Em ambas as fases&#44; as benzodiazepinas e a fenito&#237;na poderiam ser administradas pela via intra&#243;ssea&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Coment&#225;rio sobre o tempo no DE</span><p id="par0090" class="elsevierStylePara elsevierViewall">N&#227;o houve discrep&#226;ncia significativa entre as diretrizes a respeito do momento para iniciar cada fase de terapia com medicamentos anticonvulsivos&#46; Todas as diretrizes recomendam &#8220;iniciar o cron&#244;metro&#8221; quando uma convuls&#227;o durar mais de cinco minutos&#44; o que pode ser levado em considera&#231;&#227;o sempre que um paciente com convuls&#227;o ativa chegar ao DE&#46; Esse ponto temporal tamb&#233;m &#233; compat&#237;vel com a nova defini&#231;&#227;o e classifica&#231;&#227;o da ILAE de EME&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Uma diferen&#231;a insignificante com rela&#231;&#227;o ao tempo &#233; observada nas diretrizes com rela&#231;&#227;o ao per&#237;odo necess&#225;rio para uma fase de estabiliza&#231;&#227;o e os diferentes intervalos entre administrar as op&#231;&#245;es de medicamentos anticonvulsivos &#40;veja abaixo&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Primeira fase da terapia anticonvulsiva no DE</span><p id="par0095" class="elsevierStylePara elsevierViewall">No que diz respeito &#224; escolha do tratamento com medicamentos anticonvulsivos&#44; uma benzodiazepina foi recomendada por todas as diretrizes na fase inicial de terapia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> e <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46; O lorazepam intravenoso foi recomendado em 10 das diretrizes&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;10&#44;12&#44;14&#44;15&#44;17</span></a> seguido pelo diazepam intravenoso em oito das diretrizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7&#44;10&#44;12&#44;14&#8211;17</span></a> Na impossibilidade de obter acesso intravenoso&#44; o medicamento anticonvulsivo recomendado com mais frequ&#234;ncia foi o midazolam&#58; midazolam intramuscular &#40;n &#61; 8&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;8&#44;10&#44;12&#44;15&#8211;17</span></a> midazolam bucal &#40;n &#61; 8&#41;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7&#44;9&#44;10&#44;12&#44;15&#8211;17</span></a> ou midazolam intranasal &#40;n &#61; 5&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7&#44;12&#44;15&#44;16</span></a> Como op&#231;&#227;o&#44; o diazepam retal &#40;n &#61; 7&#41; foi comumente recomendado&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;7&#44;8&#44;12&#44;15&#8211;17</span></a> Uma dose repetida de benzodiazepina foi recomendada em cinco diretrizes&#44; quatro levaram em considera&#231;&#227;o a dose pr&#233;&#8208;hospitalar recebida&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7&#44;9&#44;10</span></a> e uma excluiu a dose pr&#233;&#8208;hospitalar&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> O fenobarbital intravenoso foi recomendado como uma op&#231;&#227;o &#224; benzodiazepina em duas das diretrizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;15</span></a></p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Coment&#225;rio sobre a primeira fase da terapia anticonvulsiva no DE</span><p id="par0100" class="elsevierStylePara elsevierViewall">O lorazepam e o diazepam intravenosos foram as benzodiazepinas intravenosas mais comumente recomendadas na primeira fase de terapia&#46; Todas as diretrizes recomendaram o lorazepam intravenoso&#44; exceto a diretriz da Sociedade Espanhola de Neurologia&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Na Espanha&#44; em 2016&#44; o lorazepam intravenoso n&#227;o estava dispon&#237;vel&#44; ent&#227;o&#44; em vez disso&#44; o clonazepam intravenoso era recomendado&#46; O lorazepam ou o diazepam intravenosos s&#227;o eficazes e seguros&#46; Por exemplo&#44; em um ensaio cl&#237;nico controlado e randomizado&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> que comparou o lorazepam intravenoso e o diazepam intravenoso&#44; 72&#44;9&#37; do grupo lorazepam e 72&#44;1&#37; do grupo diazepam apresentaram interrup&#231;&#227;o do EME em 10 minutos sem recorr&#234;ncia nos 30 minutos seguintes&#44; com taxas semelhantes de ventila&#231;&#227;o assistida &#40;17&#44;6&#37; no grupo lorazepam e 16&#44;0&#37; no grupo diazepam&#41;&#46; No ambiente com recursos limitados&#44; uma considera&#231;&#227;o adicional com o uso do lorazepam &#233; a necessidade de refrigera&#231;&#227;o do medicamento devido &#224; sua degrada&#231;&#227;o em alta temperatura&#46; Apesar de tanto o lorazepam quanto o diazepam intravenosos estarem inclu&#237;dos na lista de medicamentos essenciais para crian&#231;as da OMS&#44; a diretriz da ETAT recomenda o diazepam intravenoso em regi&#245;es de alta temperatura sem instala&#231;&#227;o de refrigera&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Quando uma dose repetida de benzodiazepina &#233; necess&#225;ria devido a uma convuls&#227;o cont&#237;nua&#44; quatro das 11 diretrizes<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7&#44;9&#44;10</span></a> recomendaram levar em considera&#231;&#227;o se alguma dose de benzodiazepina pr&#233;&#8208;hospitalar foi administrada&#44; pois a dosagem dos SEM afetaria a escolha do pr&#243;ximo medicamento anticonvulsivo&#46; Curiosamente&#44; essas quatro diretrizes foram publicadas ap&#243;s 2008&#44; quando Chin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> mostraram que no acometimento da comunidade referente ao EME convulsivo na inf&#226;ncia n&#227;o houve associa&#231;&#227;o entre tratamento com medicamentos anticonvulsivos pr&#233;&#8208;hospitalar ou o uso de mais de duas doses de benzodiazepinas com a dura&#231;&#227;o do EME por mais de 60 minutos&#46; Al&#233;m disso&#44; esse tratamento com mais de duas doses de benzodiazepinas foi associado &#224; depress&#227;o respirat&#243;ria&#46; Apenas uma diretriz&#44; de 2000&#44; recomendou n&#227;o considerar o tratamento de SEM anteriores&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> com base na poss&#237;vel variabilidade da dosagem pr&#233;&#8208;hospitalar&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Segunda fase da terapia anticonvulsiva no DE</span><p id="par0110" class="elsevierStylePara elsevierViewall">Na segunda fase de terapia &#40;<a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> e <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; as recomenda&#231;&#245;es das diretrizes para medica&#231;&#227;o intravenosa inclu&#237;am&#58; fenito&#237;na &#40;n &#61; 10&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;10&#44;12&#44;14&#44;16&#44;17</span></a> fenobarbital &#40;n &#61; 9&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;10&#44;14&#8211;17</span></a> &#225;cido valproico &#40;n &#61; 6&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;10&#44;14&#8211;17</span></a> fosfenito&#237;na &#40;n &#61; 4&#41;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;12&#44;14&#44;15</span></a> e levetiracetam &#40;n &#61; 4&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;15&#8211;17</span></a> Na impossibilidade de obter acesso intravenoso&#44; a fenito&#237;na intra&#243;ssea foi recomendada em tr&#234;s diretrizes<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;7</span></a> e as outras op&#231;&#245;es apresentadas foram fosfenito&#237;na<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> ou fenobarbital<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> via intramuscular e paralde&#237;do retal&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;7</span></a></p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Coment&#225;rio sobre a segunda fase da terapia anticonvulsiva no DE</span><p id="par0120" class="elsevierStylePara elsevierViewall">A fenito&#237;na intravenosa foi a terapia mais comumente recomendada para o EME resistente &#224; benzodiazepina&#46; Juntamente com a fosfenito&#237;na intravenosa &#40;o pr&#243;&#8208;f&#225;rmaco da fenito&#237;na&#41;&#44; foi a terapia de segunda fase preferida em todas as diretrizes&#46; H&#225; diversas raz&#245;es pelas quais a fosfenito&#237;na deve ser recomendada em vez da fenito&#237;na&#58; ela n&#227;o exige o excipiente propileno glicol&#59; ela apresenta menos risco de hipotens&#227;o e disritmia card&#237;aca&#59; ela n&#227;o causa s&#233;ria rea&#231;&#227;o de extravasamento&#44; s&#237;ndrome da luva roxa&#59; e pode ser administrada via intramuscular quando o acesso intravenoso n&#227;o for poss&#237;vel&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">O fenobarbital intravenoso foi recomendado em nove das 11 diretrizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#8211;10&#44;14&#8211;17</span></a> Duas diretrizes recomendaram o fenobarbital apenas se o paciente tiver recebido fenito&#237;na&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;16</span></a> O motivo disso &#233; que o fenobarbital tem mais efeitos colaterais calmantes do que a fenito&#237;na &#40;por exemplo&#44; depress&#227;o respirat&#243;ria e seda&#231;&#227;o&#41;&#44; principalmente quando as benzodiazepinas j&#225; foram usadas&#46; As evid&#234;ncias com rela&#231;&#227;o ao uso do fenobarbital intramuscular t&#234;m como base a pr&#225;tica pedi&#225;trica em mal&#225;ria cerebral&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> Por exemplo&#44; uma dose intramuscular de 20<span class="elsevierStyleHsp" style=""></span>mg&#47;kg reduz a frequ&#234;ncia das convuls&#245;es&#44; por&#233;m causa um risco mais elevado de depress&#227;o respirat&#243;ria e mortalidade&#44; principalmente nos indiv&#237;duos que j&#225; receberam v&#225;rias doses de diazepam&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">O &#225;cido valproico foi recomendado em seis das 11 diretrizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;10&#44;14&#8211;17</span></a> O &#225;cido valproico pode ser hepatot&#243;xico e pode levar &#224; hiperamonemia&#46; Tr&#234;s das diretrizes indicam que ele deve ser evitado ou usado com cautela em crian&#231;as com doen&#231;a hep&#225;tica &#40;ou suspeita de doen&#231;a metab&#243;lica&#41; e em crian&#231;as com menos de dois a tr&#234;s anos com a etiologia da convuls&#227;o incerta&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;12&#44;14</span></a> O &#225;cido valproico causa menos hipotens&#227;o ou depress&#227;o respirat&#243;ria em compara&#231;&#227;o com a fenito&#237;na ou o fenobarbital&#46; Por exemplo&#44; em um ensaio cl&#237;nico controlado e randomizado&#44; apesar de a inje&#231;&#227;o intravenosa r&#225;pida de &#225;cido valproico ter interrompido convuls&#245;es em uma taxa compar&#225;vel ao fenobarbital intravenoso &#40;90&#37; em compara&#231;&#227;o com 77&#37;&#44; sem diferen&#231;a estat&#237;stica&#41;&#44; a taxa de efeitos adversos foi menor &#40;24&#37;&#44; em compara&#231;&#227;o com 74&#37;&#41; e o grupo fenobarbital apresentou mais letargia&#44; v&#244;mito ou depress&#227;o respirat&#243;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Em compara&#231;&#227;o com a fenito&#237;na intravenosa&#44; o &#225;cido valproico &#233; t&#227;o efetivo quanto ela no controle da convuls&#227;o e mais bem tolerado com rela&#231;&#227;o ao risco de hipotens&#227;o e depress&#227;o respirat&#243;ria&#44; por&#233;m causa um leve aumento das enzimas do f&#237;gado&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> No geral&#44; o &#225;cido valproico pode ser considerado uma op&#231;&#227;o efetiva para a segunda fase da terapia medicamentosa anticonvulsiva&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">O levetiracetam foi recomendado em quatro das 11 diretrizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;15&#8211;17</span></a> Ele tem as vantagens de boa tolerabilidade&#44; administra&#231;&#227;o intravenosa durante um per&#237;odo de tempo relativamente curto e aus&#234;ncia de efeitos hemodin&#226;micos e sedativos&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Isso posto&#44; n&#227;o existem ensaios cl&#237;nicos randomizados controlados do levetiracetam no EME convulsivo pedi&#225;trico&#46; Um estudo piloto randomizado aberto demonstrou equival&#234;ncia da efic&#225;cia no controle de convuls&#245;es com o lorazepam e que h&#225; menos depress&#227;o respirat&#243;ria e hipotens&#227;o associadas ao seu uso&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Por fim&#44; h&#225; um estudo de efic&#225;cia comparativo&#44; randomizado&#44; multic&#234;ntrico e cont&#237;nuo relevante para o futuro da segunda fase do tratamento com medicamentos anticonvulsivos&#44; o Estudo do Tratamento do Estado de Mal Epil&#233;ptico Estabelecido &#40;ESETT&#59; consulte ClinicalTrials&#46;gov Identifica&#231;&#227;o&#58; NCT01960075&#59; a ser conclu&#237;do em dezembro de 2019&#41;&#44; que procura determinar o tratamento do DE mais efetivo entre a fosfenito&#237;na&#44; o levetiracetam e o &#225;cido valproico para EME resistente a benzodiazepina e fornece informa&#231;&#245;es sobre a efic&#225;cia e seguran&#231;a em crian&#231;as&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Terceira fase da terapia anticonvulsiva no DE</span><p id="par0145" class="elsevierStylePara elsevierViewall">Na terceira fase de terapia &#40;<a class="elsevierStyleCrossRef" href="#fig0020">figura 4</a> e <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#44; quatro diretrizes inclu&#237;ram a op&#231;&#227;o de repetir a terapia da segunda fase&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10&#44;12&#44;15</span></a> Nove diretrizes recomendaram induzir a anestesia com tiopental&#59;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;9&#44;12&#44;15&#8211;17</span></a> todas as quatro diretrizes que recomendaram r&#225;pida intuba&#231;&#227;o na sequ&#234;ncia sugeriram o tiopental como agente de indu&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#8211;7&#44;9</span></a> Sete das diretrizes recomendaram usar infus&#227;o de midazolam&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;10&#44;12&#44;15&#8211;17</span></a> seis recomendaram infus&#227;o de propofol&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;8&#44;10&#44;15&#8211;17</span></a> e tr&#234;s recomendaram infus&#227;o de pentobarbital&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;15</span></a></p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Coment&#225;rio sobre a terceira fase da terapia anticonvulsiva no DE</span><p id="par0150" class="elsevierStylePara elsevierViewall">No momento de iniciar a terceira fase do tratamento com medicamentos anticonvulsivos&#44; quatro das 11 diretrizes inclu&#237;ram a op&#231;&#227;o de repetir a terapia da segunda fase&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10&#44;12&#44;15</span></a> A diretriz<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> do Comit&#234; de Cuidados Agudos da Sociedade Pedi&#225;trica Canadense recomendou uma combina&#231;&#227;o que usa duas terapias medicamentosas da segunda fase&#44; separadas por um intervalo de cinco minutos&#44; antes de avan&#231;ar para a indu&#231;&#227;o da anestesia&#46; A diretriz do grupo da Associa&#231;&#227;o de Neurologia Infantil &#40;&#205;ndia&#44; 2013&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> considerou o cen&#225;rio quando nenhuma cama da unidade de terapia intensiva estiver dispon&#237;vel e recomendou o seguinte antes de usar uma infus&#227;o de midazolam&#58; &#225;cido valproico e fenobarbital&#59; ou levetiracetam&#46; A diretriz<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> da Liga Italiana contra Epilepsia recomendou o &#225;cido valproico ap&#243;s a terapia da segunda fase&#44; caso o atraso ou a dificuldade na intuba&#231;&#227;o endotraqueal sejam esperados&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Por fim&#44; a respeito da escolha do agente anest&#233;sico&#44; as diretrizes n&#227;o apresentam recomenda&#231;&#245;es claras com rela&#231;&#227;o &#224; prefer&#234;ncia entre tiopental&#44; midazolam&#44; propofol e pentobarbital&#46; Em vez disso&#44; a escolha do medicamento espec&#237;fico fica a crit&#233;rio do especialista local&#46; Deve ser observado&#44; contudo&#44; que embora o propofol seja usado na pr&#225;tica adulta do EME persistente&#44; o risco de s&#237;ndrome da infus&#227;o do propofol em crian&#231;as &#233; inaceit&#225;vel e&#44; portanto&#44; a infus&#227;o cont&#237;nua n&#227;o &#233; recomendada em v&#225;rios pa&#237;ses&#46; No que diz respeito a outros agentes anest&#233;sicos&#44; os dados sobre tratamento de terapia intensiva do EME pedi&#225;trico persistente s&#227;o de baixa qualidade&#44; embora demostrem uma hierarquia em estrat&#233;gias&#58; midazolam no in&#237;cio por infus&#227;o cont&#237;nua&#44; ent&#227;o barbituratos e&#44; por fim&#44; tentativa de outras terapias para anestesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">27&#44;28</span></a> E recentemente um estudo observacional prospectivo de dois anos avaliou o uso de infus&#227;o cont&#237;nua do agente anest&#233;sico em pacientes pedi&#225;tricos &#40;faixa et&#225;ria&#44; um m&#234;s a 21 anos&#41; e EME persistente n&#227;o respondeu a duas classes de medicamentos anticonvulsivos&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> O Grupo de Pesquisa em EME Pedi&#225;trico dos Estados Unidos constatou que&#44; em seus 11 centros&#44; o midazolam e o pentobarbital continuam a ser os principais agentes da terapia de infus&#227;o cont&#237;nua&#46;</p></span></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conclus&#227;o</span><p id="par0160" class="elsevierStylePara elsevierViewall">Lidar com uma crian&#231;a que chega a uma emerg&#234;ncia com uma convuls&#227;o &#233; um desafio e saber como lidar da melhor forma com interven&#231;&#245;es agudas e acompanhamento &#233; parte fundamental da pr&#225;tica pedi&#225;trica&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> As diretrizes sobre terapia de medicamentos anticonvulsivos para convuls&#227;o ou EME antes e depois da chegada ao DE s&#227;o importantes documentos de refer&#234;ncia na terapia aguda&#46; Nesta an&#225;lise sistem&#225;tica qualitativa de 13 diretrizes regionais&#47;nacionais&#44; constatamos que cada uma delas compartilha estruturas semelhantes com rela&#231;&#227;o &#224; pr&#225;tica e aos pontos temporais&#46; Diferentes vias de administra&#231;&#227;o da benzodiazepina s&#227;o vi&#225;veis na fase pr&#233;&#8208;hospitalar &#40;SEM&#41; e na primeira fase da terapia no DE&#46; A escolha da benzodiazepina depende do acesso intravenoso&#44; da disponibilidade no local&#44; das habilidades dos prestadores de servi&#231;os de sa&#250;de e dos recursos&#46; O &#225;cido valproico e o levetiractam apresentam perfis de efeitos colaterais melhores do que a fenito&#237;na ou a fosfenito&#237;na&#46; A compara&#231;&#227;o direta da efic&#225;cia e seguran&#231;a de diferentes terapias da segunda fase para o EME aguarda futuros estudos cl&#237;nicos&#46; Por fim&#44; quando se trata de usar agentes anest&#233;sicos em crian&#231;as&#44; a maior parte das experi&#234;ncias e da literatura usa o midazolam e&#44; ent&#227;o&#44; o pentobarbital por infus&#227;o cont&#237;nua&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflitos de interesse</span><p id="par0165" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This systematic review of national or regional guidelines published in English aimed to better understand variance in pre&#8208;hospital and emergency department treatment of status epilepticus&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Sources</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Systematic search of national or regional guidelines &#40;January 2000 to February 2017&#41; contained within PubMed and Google Scholar databases&#44; and article reference lists&#46; The search keywords were status epilepticus&#44; prolonged seizure&#44; treatment&#44; and guideline&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Summary of findings</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">356 articles were retrieved and 13 were selected according to the inclusion criteria&#46; In all six pre&#8208;hospital guidelines&#44; the preferred route of medication administration was to use alternatives to the intravenous route&#58; all recommended buccal and intranasal midazolam&#59; three also recommended intramuscular midazolam&#44; and five recommended using rectal diazepam&#46; All 11 emergency department guidelines described three phases in therapy&#46; Intravenous medication&#44; by phase&#44; was indicated as such&#58; initial phase &#8211; ten&#47;11 guidelines recommended lorazepam&#44; and eight&#47;11 recommended diazepam&#59; second phase &#8211; most &#40;ten&#47;11&#41; guidelines recommended phenytoin&#44; but other options were phenobarbital &#40;nine&#47;11&#41;&#44; valproic acid &#40;six&#47;11&#41;&#44; and either fosphenytoin or levetiracetam &#40;each four&#47;11&#41;&#59; third phase &#8211; four&#47;11 guidelines included the choice of repeating second phase therapy&#44; whereas the other guidelines recommended using a variety of intravenous anesthetic agents &#40;thiopental&#44; midazolam&#44; propofol&#44; and pentobarbital&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">All of the guidelines share a similar framework for management of status epilepticus&#46; The choice in route of administration and drug type varied across guidelines&#46; Hence&#44; the adoption of a particular guideline should take account of local practice options in health service delivery&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Sources"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Summary of findings"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Esta an&#225;lise sistem&#225;tica de diretrizes nacionais ou regionais publicadas em ingl&#234;s tem como objetivo entender melhor a diferen&#231;a no tratamento do estado de mal epil&#233;ptico pr&#233;&#8208;hospitalar e no departamento de emerg&#234;ncia&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Fontes</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Pesquisa sistem&#225;tica de diretrizes nacionais ou regionais &#40;janeiro de 2000 a fevereiro de 2017&#41; contidas nas bases de dados do Pubmed e do Google Acad&#234;mico e listas de refer&#234;ncia de artigos&#46; As palavras&#8208;chave da busca foram estado de mal epil&#233;ptico&#44; convuls&#227;o prolongada&#44; tratamento e diretriz&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resumo dos achados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram identificados 356 artigos e 13 foram selecionados de acordo com os crit&#233;rios de inclus&#227;o&#46; Em todas as seis diretrizes pr&#233;&#8208;hospitalares&#44; o caminho preferencial de administra&#231;&#227;o da medica&#231;&#227;o foi usar op&#231;&#245;es &#224; via intravenosa&#58; todas recomendaram midazolam bucal e intranasal&#59; tr&#234;s tamb&#233;m recomendaram midazolam intramuscular&#59; e cinco recomendaram usar o diazepam via retal&#46; Todas as 11 diretrizes de departamento de emerg&#234;ncia descreveram tr&#234;s fases na terapia&#46; No que diz respeito &#224; medica&#231;&#227;o intravenosa&#44; por fase&#44; temos&#58; fase inicial &#8211; 10&#47;11 diretrizes recomendaram lorazepam e 8&#47;11 recomendaram diazepam&#59; segunda fase &#8211; a maioria &#40;10&#47;11&#41; das diretrizes recomendou fenito&#237;na&#44; por&#233;m outras op&#231;&#245;es foram fenobarbital &#40;9&#47;11&#41;&#44; &#225;cido valproico &#40;6&#47;11&#41; e fosfenito&#237;na ou levetiracetam &#40;individualmente&#44; 4&#47;11&#41;&#59; terceira fase &#8211; 4&#47;11 diretrizes inclu&#237;ram a op&#231;&#227;o de repetir a terapia da segunda fase&#44; ao passo que as outras diretrizes recomendaram usar diversos agentes anest&#233;sicos intravenosos &#40;tiopental&#44; midazolam&#44; propofol e pentobarbital&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Todas as diretrizes compartilham uma estrutura semelhante para manejo do estado de mal epil&#233;ptico&#46; A escolha da via de administra&#231;&#227;o e do tipo de medicamento variou em todas as diretrizes&#46; Assim&#44; a ado&#231;&#227;o de uma diretriz espec&#237;fica deve levar em considera&#231;&#227;o as op&#231;&#245;es da pr&#225;tica local na presta&#231;&#227;o de servi&#231;os de sa&#250;de&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Fontes"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resumo dos achados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Au CC&#44; Branco RG&#44; Tasker RC&#46; Management protocols for status epilepticus in the pediatric emergency room&#58; systematic review article&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;84&#8211;94&#46;</p>"
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "Alto" => 2093
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tratamento de SEM pr&#233;&#8208;hospitalares&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">B&#44; bucal&#59; BDZ&#44; benzodiazepina&#59; DE&#44; departamento de emerg&#234;ncia&#59; SEM&#44; sistema de emerg&#234;ncia m&#233;dica&#59; IO&#44; intra&#243;ssea&#59; IN&#44; intranasal&#59; IM&#44; intramuscular&#59; IV&#44; intravenosa&#59; R&#44; retal&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Nota</span>&#58; O n&#250;mero entre par&#234;nteses &#233; o n&#250;mero da diretriz&#44; entre seis diretrizes nessa categoria &#40;veja o texto para obter mais detalhes&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2038
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Primeira fase do tratamento no DE&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ABCDEFG&#44; suporte de estabiliza&#231;&#227;o com interven&#231;&#227;o de vias a&#233;reas&#44; respira&#231;&#227;o&#44; circula&#231;&#227;o&#44; dextrose&#44; neurologia essencial&#44; fluidos&#44; quadro geral&#59; BDZ&#44; benzodiazepina&#59; DE&#44; departamento de emerg&#234;ncia&#59; SEM&#44; sistema de emerg&#234;ncia m&#233;dica&#59; IO&#44; intra&#243;ssea&#59; IN&#44; intranasal&#59; IM&#44; intramuscular&#59; IV&#44; intravenosa&#59; IVA&#44; acesso intravenoso&#59; R&#44; retal&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Nota</span>&#58; O n&#250;mero entre par&#234;nteses &#233; o n&#250;mero da diretriz&#44; entre 11 diretrizes nessa categoria &#40;veja o texto para obter mais detalhes&#41;&#46;</p>"
        ]
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      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1787
            "Ancho" => 1500
            "Tamanyo" => 199008
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Segunda fase do tratamento no DE&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">DE&#44; departamento de emerg&#234;ncia&#59; f&#8208;PHT&#44; fosfenito&#237;na&#59; IO&#44; intra&#243;ssea&#59; IN&#44; intranasal&#59; IM&#44; intramuscular&#59; IV&#44; intravenosa&#59; R&#44; retal&#46;</p> <p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Nota</span>&#58; O n&#250;mero entre par&#234;nteses &#233; o n&#250;mero da diretriz&#44; entre onze diretrizes nessa categoria &#40;veja o texto para obter mais detalhes&#41;&#46;</p>"
        ]
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      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1815
            "Ancho" => 2083
            "Tamanyo" => 223862
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Terceira fase do tratamento no DE&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">cEEG&#44; eletroencefalograma cont&#237;nuo&#59; DE&#44; departamento de emerg&#234;ncia&#59; UTI&#44; unidade de terapia intensiva&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Nota</span>&#58; O n&#250;mero entre par&#234;nteses &#233; o n&#250;mero da diretriz&#44; entre 11 diretrizes nessa categoria &#40;veja o texto para obter mais detalhes&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">A&#44; adulto&#59; Aus&#47;NZ&#44; Austr&#225;lia e Nova Zel&#226;ndia&#59; DE&#44; Departamento de Emerg&#234;ncia&#59; ETAT&#44; avalia&#231;&#227;o de triagem e tratamento de emerg&#234;ncia pedi&#225;trica&#59; EUA&#44; Estados Unidos da Am&#233;rica&#59; NHS&#44; Servi&#231;o Nacional de Sa&#250;de&#59; P&#44; pedi&#225;trico&#59; RU&#44; Reino Unido&#59; S&#44; sim&#59; SEM&#44; Servi&#231;os de Emerg&#234;ncia M&#233;dica&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Ano&#44; n&#176; de ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Pa&#237;s ou regi&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Feito por&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Popula&#231;&#227;o &#40;A&#44; P&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Escopo</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SEM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2014&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Servi&#231;os de Emerg&#234;ncia M&#233;dica para Crian&#231;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2015&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Joint Royal Colleges Ambulance Liaison Committee</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2011&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Canad&#225;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Comit&#234; de Cuidados Agudos da Sociedade Pedi&#225;trica Canadense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2013&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">It&#225;lia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Liga Italiana contra Epilepsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2014&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#205;ndia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Associa&#231;&#227;o de Neurologia Infantil &#40;&#205;ndia&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2016&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ETAT da Organiza&#231;&#227;o Mundial de Sa&#250;de&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2000&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Associa&#231;&#227;o de Neurologia Pedi&#225;trica Brit&#226;nica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2009&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aus&#47;NZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pesquisa Pedi&#225;trica Internacional Colaborativa em DEs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2012&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade de Cuidados Neurocr&#237;ticos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2012&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Instituto Nacional de Excel&#234;ncia de Atendimento e Sa&#250;de do NHS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2016&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">EUA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade Americana de Epilepsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2016&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Espanha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade Espanhola de Neurologia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2017&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hong Kong&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Sociedade de Epilepsia de Hong Kong&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&#44; P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Medicamento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Via de administra&#231;&#227;o</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Retal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bucal &#40;B&#41;&#47;Intranasal &#40;N&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intra&#243;ssea &#40;IA&#41;&#47;Intramuscular &#40;IM&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intravenosa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diazepam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;2&#8208;0&#44;5 mg&#47;kg&#47;dose<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IO&#58; 0&#44;25 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15&#8208;0&#44;2 mg&#47;kg x2 doses<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;5 mg&#47;kg&#47;dose<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;2&#8208;0&#44;3 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;5 mg&#47;kg x 2 doses<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;25 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;3 mg&#47;kg x2 dose<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;5 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 mg&#59;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> 20 mg<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60; 5 anos&#44; 5 mg&#59;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> &#8805; 5 anos&#44; 10 mg&#59;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> 10 mg<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;12&#44;15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lorazepam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;1 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#58; 0&#44;1 mg&#47;kg x2 doses<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;1 mg&#47;kg x2 doses<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;7&#44;10&#44;12&#44;15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 mg<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#58; 2&#44;5 mg<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&#59; 4 mg<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 mg<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;7&#44;10&#44;12&#44;15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Midazolam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#58; 5&#8208;10 mg<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IO&#58; 0&#44;15 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IN&#58; 0&#44;2 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IM&#58; 0&#44;15 mg&#47;kg x 2 doses<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15&#8208;0&#44;2 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IM&#58; 0&#44;2 mg&#47;kg x 2 doses<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;2 mg&#47;kg x2 doses<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IN&#58; 5 mg&#47;nostril<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IM&#58; 5 mg&#59;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> 13&#8208;40<span class="elsevierStyleHsp" style=""></span>kg&#44; 5 mg&#59;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> &#62; 40<span class="elsevierStyleHsp" style=""></span>kg&#44; 10 mg&#59;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> 10 mg<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fosfenito&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;EF&#44; equivalentes da fenito&#237;na&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IM&#58; 20<span class="elsevierStyleHsp" style=""></span>mg PE&#47;kg<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20<span class="elsevierStyleHsp" style=""></span>mg PE&#47;kg<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;12&#44;15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IM&#58; 1000<span class="elsevierStyleHsp" style=""></span>mg PE<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1000<span class="elsevierStyleHsp" style=""></span>mg PE&#59;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> 1500<span class="elsevierStyleHsp" style=""></span>mg PE<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fenito&#237;na&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IO&#58; 20 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#8208;20 mg&#47;kg<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#8208;20 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IO&#58; 1000 mg<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 mg&#47;kg<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;7&#44;12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1000 mg<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">11&#44;16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fenobarbital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#8208;20 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 mg&#47;kg&#47;dose<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#8208;20 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 mg&#47;kg<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1000 mg<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#193;cido valproico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#8208;45 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#8208;45 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 mg&#47;kg<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1500 mg&#59;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> 3000 mg<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Levetiracetam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&#243;lus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#8208;30 mg&#47;kg<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60 mg&#47;kg<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dose m&#225;xima&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4500 mg<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "pt" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Medicamentos anticonvulsivos imediatos normalmente usados&#44; via de administra&#231;&#227;o e dosagem</p>"
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        "etiqueta" => "Tabela 3"
        "tipo" => "MULTIMEDIATABLA"
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            "detalle" => "Tabela "
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          "leyenda" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Grupos</span>&#58; AES&#44; Sociedade Americana de Epilepsia&#59; AOCN&#44; Associa&#231;&#227;o de Neurologia Infantil &#40;&#205;ndia&#41;&#59; BPNA&#44; Associa&#231;&#227;o de Neurologia Pedi&#225;trica Brit&#226;nica&#59; CPS&#44; Sociedade Pedi&#225;trica Canadense&#59; HKES&#44; Sociedade de Epilepsia de Hong Kong&#59; LICE&#44; Liga Italiana contra Epilepsia&#59; NCS&#44; Sociedade de Cuidados Neurocr&#237;ticos&#59; NICE&#44; Instituto Nacional de Excel&#234;ncia de Atendimento e Sa&#250;de do Servi&#231;o Nacional de Sa&#250;de&#59; OMS&#44; Organiza&#231;&#227;o Mundial de Sa&#250;de&#59; Predict&#44; Pesquisa Pedi&#225;trica Internacional Colaborativa em Departamentos de Emerg&#234;ncia&#59; SEN&#44; Sociedade Espanhola de Neurologia&#46;</p><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Terapias</span>&#58; DZ&#44; diazepam&#59; f&#8208;PHT&#44; fosfenito&#237;na&#59; Lev&#44; levetiracetam&#59; LZ&#44; lorazepam&#59; MZ&#44; midazolam&#59; Par&#44; paralde&#237;do&#59; PB&#44; fenobarbital&#59; Pent&#44; pentobarbital&#59; Pfl&#44; propofol&#59; PHT&#44; fenito&#237;na&#59; TH&#44; tiopental&#59; VPA&#44; &#225;cido valproico&#46;</p><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Vias&#58;</span> b&#44; bucal&#59; im&#44; intramuscular&#59; in&#44; intranasal&#59; io&#44; intra&#243;ssea&#59; iv&#44; intravenosa&#59; r&#44; retal&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Ano&#44; n&#176; de ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Grupo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Terapias<br>da primeira fase</th><th class="td" title="table-head  " colspan="6" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Terapias<br>da segunda fase</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Terapias<br>da terceira fase</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PHT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">f&#8208;PHT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VPA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lev&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Par&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">TH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MZ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pfl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2000&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">BPNA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; io&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2009&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PREDICT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; io&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; io&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&#44; b&#44; in&#44; io&#44; iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; io&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2011&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">CPS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&#44; b&#44; in&#44; iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; io&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; im&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2012&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NCS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2012&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NICE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2013&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LICE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&#44; b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2014&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AOCN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&#44; b&#44; in&#44; iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2016&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OMS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; im&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2016&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&#44; b&#44; in&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2016&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SEN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&#44; b&#44; in&#44; iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2017&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HKES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&#44; r&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">im&#44; b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">iv&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "pt" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Compara&#231;&#227;o de medicamentos anticonvulsivos usados em cada uma das tr&#234;s fases de terapia e suas vias de administra&#231;&#227;o &#40;veja tamb&#233;m as tabelas 1 e 2&#41;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
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                      "autores" => array:1 [
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                          "etal" => true
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "Revista" => array:6 [
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                        "fecha" => "2015"
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                        "link" => array:1 [
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            1 => array:3 [
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                      "autores" => array:1 [
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                          "etal" => false
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                            0 => "Provisional Committee on Quality Improvement&#44; Subcommittee on Febrile Seizures"
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            2 => array:3 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => true
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                      "Revista" => array:6 [
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            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preferred reporting items for systematic reviews and meta&#8208;analyses&#58; the PRISMA statement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Moher"
                            1 => "A&#46; Liberati"
                            2 => "J&#46; Tetzlaff"
                            3 => "D&#46;G&#46; Altman"
                            4 => "The PRISMA Group"
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                      ]
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                  ]
                  "host" => array:1 [
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                        "fecha" => "2009"
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                        "paginaInicial" => "e1000097"
                        "link" => array:1 [
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