title: The management of Convulsive Refractory Status Epilepticus in adults in the UK: No consistency in practice and little access to continuous EEG monitoring.
abstract: OBJECTIVE
  Convulsive Status Epilepticus (CSE) is a common neurological emergency with patients presenting with prolonged epileptic activity. Sub-optimal management is coupled with high morbidity and mortality. Continuous electroencephalogram (EEG) monitoring is considered essential by the National Institute for Health and Care Excellence (NICE) in the management of Convulsive Refractory Status Epilepticus (CRSE). The aim of this research was to determine current clinical practice in the management of CRSE amongst adults in intensive care units (ICU) in the UK and establish if the use of a standardised protocol requires re-enforcement within trusts.
  
  
  METHODS
  75 randomly selected UK NHS Trusts were contacted and asked to complete a questionnaire in addition to providing their protocol for CRSE management in ICU.
  
  
  RESULTS
  55 (73%) trusts responded. While 31 (56% of responders) had a protocol available in ICU for early stages of CSE, just 21 (38%) trusts had specific guidelines if CRSE occurred. Only 23 (42%) trusts involved neurologists at any stage of management and just 18 (33%) have access to continuous EEG monitoring.
  
  
  CONCLUSIONS
  This study identifies significant inconsistency in the management of CSE in ICU's across the UK. A minority of ICU units have a protocol for CRSE or access to continuous EEG monitoring despite it being considered fundamental for management and supported by NICE guidance.
authors.affiliation: Academic FY2, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B95SS, UK. Electronic address: mpatel59@doctors.org.uk.
authors.forename: Mitesh
authors.initials: M
authors.lastname: Patel
authors.affiliation: The Barberry, Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2QZ, UK. Electronic address: Manny.Bagary@bsmhft.nhs.uk.
authors.forename: Manny
authors.initials: M
authors.lastname: Bagary
authors.affiliation: Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
authors.forename: Dougall
authors.initials: D
authors.lastname: McCorry
mesh_terms: D019468:Disease Management; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008991:Monitoring, Physiologic; D013226:Status Epilepticus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006113:United Kingdom
keywords: Convulsive Refractory Status Epilepticus; Electroencephalogram; Intensive care unit; National Institute for Health and Care Excellence; Neurologists