Status epilepticus. Current concepts and management.
OBJECTIVE
To inform primary care physicians about current issues around generalized convulsive status epilepticus (GCSE) emphasizing definition, pathophysiology, treatment, and prognosis.


METHODS
MEDLINE (1994 to 1999) provided 479 references using the MeSH terms "status epilepticus" and "treatment." From these we selected 30 English-language articles covering clinical aspects, treatment, and animal research. Key source documents from previous years and information from modern textbooks and recent symposia were also included.


RESULTS
Generalized convulsive status epilepticus continues to be a medical emergency with high morbidity and mortality. It must be managed promptly and effectively. The operational definition of GCSE is a seizure that lasts longer than 5 minutes or two or more seizures between which patients do not recover. Main differential diagnosis is nonepileptic status. Intravenous therapy with combined lorazepam and phenytoin is the initial treatment of choice. Other preferred medications are diazepam, midazolam, and propofol. Some of these medications should be considered before arrival at hospital. Prognosis of GCSE is determined by underlying cause, delay in adequate treatment, and comorbidity. Patients with GCSE lasting longer than 30 minutes require intensive care and electroencephalogram monitoring.


CONCLUSIONS
Intravenous lorazepam and phenytoin are currently the most effective drugs for initial management of GCSE. Timely administration of antiepileptic medication can prevent development of GCSE in some patients with known epilepsy. Main differential diagnosis is nonepileptic status.
Starreveld
E
E
Adult Convulsive Disorder Clinic, Glenrose Rehabilitation Hospital. adaleist@compusmart.ab.ca
Starreveld
A A
AA
D000927:Anticonvulsants / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D003422:Critical Care; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004630:Emergencies; D005194:Family Practice; D006801:Humans; D008991:Monitoring, Physiologic; D009017:Morbidity; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology
D000927:Anticonvulsants