Skip to Main Content

++

LEARNING OBJECTIVES

++

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Describe the pathophysiology of status epilepticus.

  2. Explain the urgency of diagnosis and treatment of status epilepticus.

  3. Recognize the signs and symptoms of status epilepticus.

  4. Identify the treatment options available for termination of status epilepticus.

  5. Formulate an initial treatment strategy for a patient in generalized convulsive status epilepticus.

  6. Compare the pharmacotherapeutic options for refractory status epilepticus.

  7. Describe adverse drug events associated with the pharmacotherapy of status epilepticus.

  8. Recommend monitoring parameters for a patient in status epilepticus.

++

KEY CONCEPTS

++

  • Image not available. Status epilepticus is a neurologic emergency that can lead to permanent brain damage or death.

  • Image not available. Status epilepticus can be practically defined as continuous seizure activity lasting more than 5 minutes or two or more seizures without complete recovery of consciousness.

  • Image not available. It is important to evaluate possible etiologies of status epilepticus and treat underlying causes to obtain timely and optimal seizure control. A thorough history along with laboratory and diagnostic testing should be conducted.

  • Image not available. The goal of therapy is to terminate physical and electroencephalographic evidence of seizures, prevent their recurrence, and minimize adverse drug events.

  • Image not available. The first-line treatment for status epilepticus is IV benzodiazepines (emergent therapy). Lorazepam is currently considered the first-line agent by most clinicians.

  • Image not available. Urgent therapy with antiepileptic drugs (AEDs) should be used to prevent seizure recurrence. IV phenytoin (or fosphenytoin), valproate sodium, and phenobarbital are options after benzodiazepines.

  • Image not available. Seizure activity that does not respond to benzodiazepines (emergent therapy) and antiepileptics (urgent therapy) or persists beyond 30 to 60 minutes in duration can be considered refractory status epilepticus.

  • Image not available. Midazolam, propofol, and pentobarbital infusions are commonly used for refractory status epilepticus, but intensive monitoring and supportive care are required.

++

Image not available. Status epilepticus (SE) is a neurologic emergency that can lead to permanent brain damage or death. Image not available. SE can be practically defined as continuous seizure activity lasting more than 5 minutes or two or more seizures without complete recovery of consciousness.1 Refractory status epilepticus (RSE) can be defined as seizure activity that does not respond to first-line (emergent) or second-line (urgent) antiepileptic therapy.2

++

SE can present as nonconvulsive status epilepticus (NCSE) or generalized convulsive status epilepticus (GCSE). NCSE is characterized by a persistent state of impaired consciousness without clinical seizure activity. For patients with NCSE, electroencephalography (EEG) is essential for diagnosis. GCSE is characterized by full-body motor seizures and involves the entire brain. This chapter focuses on GCSE, the most common type of SE, which is associated with the greatest risk of neurologic and physical damage.

++

EPIDEMIOLOGY AND ETIOLOGY

++

There are an estimated 150,000 cases of SE each year in the United States, with approximately 55,000 associated deaths, and an estimated annual direct cost for inpatient admissions of $4 billion.3,4 Status epilepticus occurs more frequently in African Americans, children, and the elderly.

++

Image not available. It is ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.