Treatment of status epilepticus: a survey of neurologists.
BACKGROUND
New antiepileptic drugs (AEDs) have provided alternatives to traditional treatment paradigms for status epilepticus (SE).


METHODS
To determine current treatment preferences for generalized convulsive status epilepticus (GCSE), we surveyed 106 members of the Critical Care or Epilepsy sections of the American Academy of Neurology.


RESULTS
Most respondents initially treat patients with intravenous (IV) lorazepam (76%), followed by phenytoin or fosphenytoin (95%) if first-line therapy fails. Preferences for GCSE refractory to two AEDs (RSE) varied: 43% would give phenobarbital, 19% would give one of three continuous-infusion (cIV) AEDs (pentobarbital, midazolam, propofol), and 16% would give IV valproic acid. About half indicated "burst suppression" (56%) and half indicated "elimination of seizures" (41%) as the titration goal for cIV-AED therapy. About half (42%) would add a new cIV-AED, and the other half (41%) would not add another agent to treat electrographic SE refractory to four AEDs.


CONCLUSIONS
In accordance with published trials and general guidelines, neurologists most often use lorazepam followed by phenytoin or fosphenytoin as first-line and second-line therapies for GCSE. There is no consensus for third-line or fourth-line treatment for RSE. The treatment of RSE needs to be studied in a large, prospective, randomized, multicenter trial.
Claassen
Jan
J
Division of Critical Care Neurology, Department of Neurology, Neurological Institute, Columbia University College of Physicians and Surgeons, 710 West 168th Street, Unit 39, New York, NY 10032, USA.
Hirsch
Lawrence J
LJ
Mayer
Stephan A
SA
D000927:Anticonvulsants / Q000627:therapeutic use*; D003422:Critical Care / Q000706:statistics & numerical data; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006306:Health Surveys; D006801:Humans; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011379:Prognosis; D011897:Random Allocation; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000927:Anticonvulsants