The current state of treatment of status epilepticus.
There have been many important developments in the diagnosis and treatment of status epilepticus in the recent past. Earlier treatment, including at home by caregivers and in the field by paramedics, has been shown to be safe and effective. Rapid-acting anesthetic agents, such as midazolam and propofol, are being used more often for refractory status epilepticus, though clinical trials are lacking. Nonconvulsive status epilepticus is being considered and recognized more often, including in ambulatory patients with a confusional state, after convulsive status epilepticus, and in critically ill patients. Modern technology and continuous digital electroencephalogram (EEG) recordings have taught us many things, but have raised at least as many questions. Much work needs to be done regarding the significance of certain EEG patterns (particularly periodic discharges) and when and how to treat them. This article reviews these issues, concentrating on recent advances and practical issues related to the clinical care of patients with status epilepticus.
Hirsch
Lawrence J
LJ
Comprehensive Epilepsy Center, Columbia University Neurological Institute, Box NI-135, 710 West 168th Street, New York, NY 10032, USA. ljh3@columbia.edu
Claassen
Jan
J
D000818:Animals; D000927:Anticonvulsants / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001921:Brain / Q000033:anatomy & histology / Q000378:metabolism; D004569:Electroencephalography; D005260:Female; D018757:GABA Modulators / Q000627:therapeutic use; D006801:Humans; D008874:Midazolam / Q000627:therapeutic use; D010634:Phenobarbital / Q000627:therapeutic use; D010672:Phenytoin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D018757:GABA Modulators; D001569:Benzodiazepines; D014635:Valproic Acid; D010672:Phenytoin; D008874:Midazolam; D010634:Phenobarbital