Management of status epilepticus.
Status epilepticus is an increasingly recognized public health problem in the United States. Status epilepticus is associated with a high mortality rate that is largely contingent on the duration of the condition before initial treatment, the etiology of the condition, and the age of the patient. Treatment is evolving as new medications become available. Three new preparations--fosphenytoin, rectal diazepam, and parenteral valproate--have implications for the management of status epilepticus. However, randomized controlled trials show that benzodiazepines (in particular, diazepam and lorazepam) should be the initial drug therapy in patients with status epilepticus. Despite the paucity of clinical trials comparing medication regimens for acute seizures, there is broad consensus that immediate diagnosis and treatment are necessary to reduce the morbidity and mortality of this condition. Moreover, investigators have reported that status epilepticus often is not considered in patients with altered consciousness in the intensive care setting. In patients with persistent alteration of consciousness for which there is no clear etiology, physicians should be more quickly prepared to obtain electroencephalography to identify status epilepticus. Physicians should rely on a standardized protocol for management of status epilepticus to improve care for this neurologic emergency.
Sirven
Joseph I
JI
Department of Neurology, Mayo Clinic, Scottsdale, Arizona 85262, USA. Sirven.Joseph@mayo.edu
Waterhouse
Elizabeth
E
D000927:Anticonvulsants / Q000627:therapeutic use*; D004569:Electroencephalography; D006801:Humans; D017410:Practice Guidelines as Topic; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology; D013226:Status Epilepticus / Q000188:drug therapy* / Q000503:physiopathology
D000927:Anticonvulsants