Management of refractory status epilepticus in adults: still more questions than answers

Rossetti, Andrea O.; Lowenstein, Daniel H.

doi:10.1016/s1474-4422(11)70187-9

Cited by 293 publications

(260 citation statements)

References 122 publications

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“…Detailed reviews of the treatment of RSE and SRSE are provided elsewhere. 47,48 Propofol, midazolam, and thiopental are commonly used first-line anesthetics for RSE, with pentobarbital often being reserved for use as a second-line anesthetic for those patients still refractory after these initial medications. All of these medications should be given as an initial bolus followed by a maintenance infusion to assure adequate serum levels of the drugs.…”

Section: Refractory Status Epilepticus and Superrefractory Status Epimentioning

confidence: 99%

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

Betjemann

2015

Semin Neurol

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Status epilepticus (SE) represents a common neurologic emergency that if not treated appropriately and in a timely fashion can lead to significant neurologic injury and mortality. A heterogeneous disorder, SE is often organized into major categories, including generalized convulsive SE (GCSE), focal motor SE, nonconvulsive SE (NCSE), and refractory SE. The treatment of SE and outcomes are often dictated by which type of SE a patient is experiencing, the age of the patient, and the underlying etiology. Despite significant advances in research, practice patterns vary and controversy remains regarding the most appropriate treatment of the various forms of SE. Epidemiology and PrognosisWhen broadly defined as a seizure lasting more than 30 minutes or recurrent seizures with incomplete return to baseline, the annual incidence of SE ranges from 10 to 41 per 100,000 persons, or roughly 125,000 to 195,000 new cases annually in the United States. 1-5 These figures may even be underestimates, particularly in the case of NCSE, which is only diagnosed through electroencephalographic (EEG) monitoring; recent studies of inpatient EEG monitoring, particularly in the intensive care unit (ICU), have demonstrated high rates of electrographic seizures that likely are underrecognized. 6-11 Owing in part to this increase in SE detection in the hospital, the incidence of SE is increasing. 12,13 Although greatly influenced by the etiology, overall mortality estimates related to SE approach 20% 1 and are not changing dramatically over time. 12,13 When considering the causes of SE, it can be helpful to divide cases into acute and chronic etiologies. Acute symptomatic causes (i.e., stroke, metabolic, infectious, anoxic injury) tend to be more common than chronic causes (i.e., low antiepileptic drug level, alcohol abuse, tumor, remote effects from stroke) and are generally associated with a higher mortality. 2,5,14 Given the increasing Keywords ► seizures ► status epilepticus ► refractory status epilepticus ► epidemiology ► prehospital treatment ► diagnostic evaluation AbstractStatus epilepticus is a heterogeneous disorder with varied definitions and presentations. Taken together, all forms of status epilepticus carry significant morbidity and mortality, much of which is dictated by the underlying etiology. Generalized convulsive status epilepticus, which represents a common form, is a true neurologic emergency that requires emergent management. Treatment focuses on stabilizing the patient and aggressive medical management to achieve the timely termination of seizures. For other forms of status epilepticus including nonconvulsive and focal status epilepticus, the goal remains early seizure termination, but the use of intravenous medications should be weighed against the risks associated with these therapies. The diagnostic evaluation of status epilepticus is guided by the patient's history and should be broad, including a screen for toxins, electrolytes, structural abnormalities, and central nervous system infectious and autoimmune/inflam...

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Section: Refractory Status Epilepticus and Superrefractory Status Epimentioning

confidence: 99%

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

Betjemann

2015

Semin Neurol

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“…[18]. In some guidelines, IV phenobarbital is still recommended, but its place in the treatment algorithm has become controversially.…”

Section: Recommendations For Treatmentmentioning

confidence: 99%

First line management of prolonged convulsive seizures in children and adults: good practice points

et al. 2013

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Over the past decades, it has become clear that the most efficient way to prevent status epilepticus is to stop the seizure as fast as possible, and early treatment of prolonged convulsive seizures has become an integral part of the overall treatment strategy in epilepsy. Benzodiazepines are the first choice drugs to be used as emergency medication. This treatment in the early phases of a seizure often implies a 'pre-medical' setting before intervention of medically trained persons. In this paper, we propose "good practice points" for first line management of prolonged convulsive seizures in children and adults in a 'pre-medical' setting.

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“…especialmente si es refractario es 3 veces mayor que después de una primera crisis epiléptica sintomática (22).…”

Section: Tratamiento En El Tercer Estadío: Estado Epiléptico Refractariounclassified

“…La dosis de carga es de 0,2 mg/kg, seguido por una infusión de 0,05 a 0,4 mg/kg/h. Es usado como monoterapia o en combinación con propofol, y una ventaja sobre los otros dos grupos es la disponibilidad de un antídoto que es el flumazenilo (9,17,19,22). El patrón de "burst…”

Section: Midazolamunclassified

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Actualización en el manejo del estado epiléptico.

Villafuerte-Espinoza¹,

Toro²,

Burneo³

2013

Rev Neuropsiquiatr

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RESUMENEl Estado Epiléptico (EE) es una emergencia médica, que requiere intervención de forma inmediata para disminuir la morbimortalidad asociada. Esta incluye el uso de medidas de soporte vital, y un tratamiento específico cuyo objetivo es detener todas las crisis ya sean clínicas o electrográficas y prevenir su recurrencia. En el presente manuscrito revisamos lo más relevante del tratamiento farmacológico en cada estadío del EE y las medidas generales concomitantes, para un manejo adecuado. PALABRAS CLAVE:Crisis epilépticas, crisis refractarias, epilepsia, estado epiléptico, tratamiento. ABSTRACTStatus Epilepticus is a medical emergency requiring immediate intervention to decrease morbidity and mortality. This includes the use of life support measures and specific treatment aimed at stopping all crises either clinical or electrographic and prevents its recurrence. In this manuscript we review the most relevant of drug treatment at each stage of the Status Epilepticus and the concomitant general measures for proper management.

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Management of refractory status epilepticus in adults: still more questions than answers

Cited by 293 publications

References 122 publications

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

Current Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus

First line management of prolonged convulsive seizures in children and adults: good practice points

Actualización en el manejo del estado epiléptico.

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