Management of status epilepticus in adults. Position paper of the Italian League against Epilepsy

Minicucci, Fabio; Ferlisi, Monica; Brigo, Francesco; Mecarelli, Oriano; Meletti, Stefano; Aguglia, Umberto; Michelucci, Roberto; Mastrangelo, Massimo; Specchio, Nicola; Sartori, Stefano; Tinuper, Paolo

doi:10.1016/j.yebeh.2019.106675

Cited by 38 publications

(20 citation statements)

References 72 publications

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“…Indeed, at least in the study of Beuchat et al a higher risk of SE refractoriness and new disability at hospital discharge was observed in more recent years, when newer AEDs have been increasingly used compared to previous years. Notably, considering the few high‐class RCTs, clinical practice is still influenced by experts' opinions, and while clinical guidelines emphasize the need for rapid control of benzodiazepine‐resistant SE, they do not provide guidance regarding the choice of medication on the basis of either efficacy or safety . To fill this gap, very recently the results of the Established Status Epilepticus Treatment Trial (ESETT), a randomized, blinded, adaptive trial that compared the efficacy and safety of levetiracetam, fosphenytoin, and valproate in children and adults with benzodiazepine‐refractory convulsive status epilepticus, have been published .…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five‐year observational study

et al. 2020

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Objective: To evaluate clinical outcomes and treatment effectiveness of status epilepticus finally resolved by nonbenzodiazepine antiepileptic drugs (AEDs). Methods: All consecutive SE episodes observed from September 1, 2013, to September 1, 2018, and resolved by AEDs were considered. Diagnosis and classification of SE followed the 2015 ILAE proposal. Nonconvulsive status (NCSE) diagnosis was confirmed according to the Salzburg EEG criteria. The modified Rankin Scale and deaths at 30 days from onset were used to evaluate outcomes. Results: A total of 277 status episodes (mean age 71 years; 61% female) were treated and resolved by antiepileptic drugs after 382 treatment trials. 68% of the SE resolved after AED use as first/second treatment line, while subsequent trials with AEDs gave an additional 32% resolution. A return to baseline conditions was observed in 48% of the patients, while overall mortality was 19% without significant changes across the study years. Mortality was higher in NCSE than in convulsive SE (22.5% vs 12.9%; P < .05), while mortality did not differ in SE episodes resolved by a first/second AED trial (17.2%) versus SE resolved by successive treatment trials (18.9%). The resolution rate of intravenous AEDs was 82% for valproate, 77% for lacosamide, 71% for phenytoin, and 62% for levetiracetam. No significant differences were found in head-to-head comparison, but for the valproate-levetiracetam one that was related to NCSE episodes in which valproate resulted to be effective in 86% of the trials while levetiracetam in 62% (P < .002). Significance: A high short-term mortality, stable over time, was observed in SE despite resolution of seizures, especially in SE with nonconvulsive semiology.Comparative AED efficacy showed no significant differences except for higher resolution rate for valproate versus levetiracetam in NCSE. K E Y W O R D Slacosamide, levetiracetam, mortality, outcomes, status epilepticus, valproate

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Section: Introductionmentioning

confidence: 99%

Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five‐year observational study

et al. 2020

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“…The clinical management of sustained seizures or SE in COVID-19 patients does not differ from the common management of SE [ 46 ]. However, it is necessary to choose appropriate anti-seizure medications (ASMs), taking into consideration drug interactions, age, respiratory, renal, hepatic, and cardiac functions [ 5 ].…”

Section: Neurological Disease Manifestationsmentioning

confidence: 99%

Insights into neurological dysfunction of critically ill COVID-19 patients

Deana

Verriello

Pauletto

et al. 2021

Trends in Anaesthesia and Critical Care

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Novel coronavirus spread rapidly around the world infecting millions of people. It was thus declared a pandemic. This new virus damages the lungs. In the most severe cases, it leads to acute respiratory failure that requires intensive care treatment. However, many clinical reports have listed different neurological symptoms, leading to increased interest in the neurological involvement of COVID-19. Various pathophysiological mechanisms have been proposed to explain these neurological aspects. Direct viral invasion of the nervous system, systemic cytokine storm and severe hypoxemia are key factors in the development of symptoms. Critically ill patients present several additional risk factors for nervous system damage. Reasons for these include deep sedation and extended muscular paralysis, bed rest for several days, and the inability to receive proper physical rehabilitation. After ICU treatment, COVID-19 patients generally require an extensive rehabilitation program. However, distancing restrictions mean that in many cases physiotherapists are unable to enter ICUs, delaying the process of rehabilitation. The role of telemedicine should be considered as an adjunctive tool in the rehabilitation of critically ill COVID-19 patients.

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“…Diazepam is the first benzodiazepine used for the treatment of epilepsy and SE. Highly lipophilic and rapidly enters the brain, diazepam can be administered intravenously as a bolus of 0.15-0.2 mg/kg up to 10 mg. [21][22][23] Considering the relatively long elimination half-life of diazepam, its rapid redis-…”

Section: Diazepammentioning

confidence: 99%

“…The dosage may be repeated once. [21][22][23]26 Midazolam Midazolam is a water-soluble benzodiazepine. At a physiologic pH, midazolam undergoes a conformational change to becomes lipophilic.…”

Section: Lorazepammentioning

confidence: 99%

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Antiepileptic Drug Therapy for Status Epilepticus

Kim

Cho

et al. 2021

J Clin Neurol

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Status epilepticus (SE) is one of the most serious neurologic emergencies. SE is a condition that encompasses a broad range of semiologic subtypes and heterogeneous etiologies. The treatment of SE primarily involves the management of the underlying etiology and the use of antiepileptic drug therapy to rapidly terminate seizure activities. The Drug Committee of the Korean Epilepsy Society performed a review of existing guidelines and literature with the aim of providing practical recommendations for antiepileptic drug therapy. This article is one of a series of review articles by the Drug Committee and it summarizes staged antiepileptic drug therapy for SE. While evidence of good quality supports the use of benzodiazepines as the first-line treatment of SE, such evidence informing the administration of second- or third-line treatments is lacking; hence, the recommendations presented herein concerning the treatment of established and refractory SE are based on case series and expert opinions. The choice of antiepileptic drugs in each stage should consider the characteristics and circumstances of each patient, as well as their estimated benefit and risk to them. In tandem with the antiepileptic drug therapy, careful searching for and treatment of the underlying etiology are required.

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Management of status epilepticus in adults. Position paper of the Italian League against Epilepsy

Cited by 38 publications

References 72 publications

Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five‐year observational study

Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five‐year observational study

Insights into neurological dysfunction of critically ill COVID-19 patients

Antiepileptic Drug Therapy for Status Epilepticus

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