Treatment of Established Status Epilepticus

Journal of Clinical Medicine

Jessica J. Falco-Walter¹  Thomas Bleck¹ 

[1] Department of Neurology, Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA;

关键词: status epilepticus;    established status epilepticus;    treatment;    antiseizure;    phenytoin;    levetiracetam;    valproic acid;    phenobarbital;    lacosamide;   

DOI  :  10.3390/jcm5050049

来源: DOAJ

【 摘 要 】

Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE.

【 授权许可】

Unknown