New management strategies in the treatment of status epilepticus.
Status epilepticus is a neurologic emergency associated with high mortality and long-term disability. Recent advances in our understanding of the pathophysiological mechanisms involved in the initiation and perpetuation of seizure activity have revealed that status epilepticus is a dynamic and evolving process. Alterations at the cellular level parallel physiological, physical, and electrical changes at the bedside. Loss of cerebral autoregulation and neuronal damage begin after 30 minutes of continuous seizure activity. This understanding has led to changes in treatments of status epilepticus, which must be multidisciplinary and occur simultaneously in many different areas. The goals of pharmacological therapy are to terminate seizures early and prevent recurrence. Two recent large clinical studies have shown the benefit of early administration of benzodiazepines to control status epilepticus. Pharmacological algorithms designed to focus medical management have trended toward earlier and more aggressive treatment. The hope is that continued exploration into the basic mechanisms involved in status epilepticus and future controlled clinical trials defining optimal medical management will produce further advances.
Manno
Edward M
EM
Department of Neurology, Mayo Clinic, Rochester, Minn 55905, USA.
D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D004632:Emergency Medical Services / Q000379:methods; D006801:Humans; D010634:Phenobarbital / Q000627:therapeutic use; D010672:Phenytoin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013226:Status Epilepticus / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D001569:Benzodiazepines; D014635:Valproic Acid; D010672:Phenytoin; C043114:fosphenytoin; D010634:Phenobarbital