title: Treatment of status epilepticus in adults: guidelines of the Italian League against Epilepsy.
abstract: Status epilepticus (SE) is a medical emergency which can lead to significant morbidity and mortality and requires prompt diagnosis and treatment. SE is differentiated into generalized or partial SE on the basis of its electro-clinical manifestations. The guidelines for the management of SE produced by the Italian League against Epilepsy also distinguish three different stages of SE (initial, established and refractory), based on time elapsed since the onset of the condition and responsiveness to previously administered drugs. Treatment should be started as soon as possible, particularly in generalized convulsive SE, and should include general support measures, drugs to suppress epileptic activity and, whenever possible, treatments aimed at relieving the underlying (causative) condition. Benzodiazepines are the first line antiepileptic agents, and i.v. lorazepam is generally preferred because it is associated with a lower risk of early relapses. If benzodiazepines fail to control seizures, i.v. phenytoin is usually indicated, though i.v. phenobarbital or i.v. valproate may also be considered. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. In refractory SE, general anesthesia may be required. Propofol and thiopental represent first line agents in this setting, after careful assessment of potential risks and benefits.
authors.affiliation: Clinical Neurophysiology, San Raffaele Hospital, Milan, Italy. minicucci.fabio@hsr.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Minicucci
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Muscas
authors.forename: Emilio
authors.initials: E
authors.lastname: Perucca
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Capovilla
authors.forename: Federico
authors.initials: F
authors.lastname: Vigevano
authors.forename: Paolo
authors.initials: P
authors.lastname: Tinuper
mesh_terms: D000328:Adult; D000367:Age Factors; D000768:Anesthesia, General / Q000379:methods; D000927:Anticonvulsants / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D006801:Humans; D007390:International Agencies; D007558:Italy; D008140:Lorazepam / Q000627:therapeutic use; D010634:Phenobarbital / Q000627:therapeutic use; D010672:Phenytoin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D015742:Propofol / Q000008:administration & dosage; D055502:Secondary Prevention; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D013874:Thiopental / Q000008:administration & dosage; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D001569:Benzodiazepines; D014635:Valproic Acid; D010672:Phenytoin; D013874:Thiopental; D008140:Lorazepam; D015742:Propofol; D010634:Phenobarbital