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2015 ; 75
(13
): 1499-521
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Pharmacotherapy for Status Epilepticus
#MMPMID26310189
Trinka E
; Höfler J
; Leitinger M
; Brigo F
Drugs
2015[Sep]; 75
(13
): 1499-521
PMID26310189
show ga
Status epilepticus (SE) represents the most severe form of epilepsy. It is one of
the most common neurologic emergencies, with an incidence of up to 61 per 100,000
per year and an estimated mortality of 20 %. Clinically, tonic-clonic convulsive
SE is divided into four subsequent stages: early, established, refractory, and
super-refractory. Pharmacotherapy of status epilepticus, especially of its later
stages, represents an "evidence-free zone," due to a lack of high-quality,
controlled trials to inform clinical decisions. This comprehensive narrative
review focuses on the pharmacotherapy of SE, presented according to the
four-staged approach outlined above, and providing pharmacological properties and
efficacy/safety data for each antiepileptic drug according to the strength of
scientific evidence from the available literature. Data sources included MEDLINE
and back-tracking of references in pertinent studies. Intravenous lorazepam or
intramuscular midazolam effectively control early SE in approximately 63-73 % of
patients. Despite a suboptimal safety profile, intravenous phenytoin or
phenobarbital are widely used treatments for established SE; alternatives include
valproate, levetiracetam, and lacosamide. Anesthetics are widely used in
refractory and super-refractory SE, despite the current lack of trials in this
field. Data on alternative treatments in the later stages are limited. Valproate
and levetiracetam represent safe and effective alternatives to phenobarbital and
phenytoin for treatment of established SE persisting despite first-line treatment
with benzodiazepines. To date there are no class I data to support
recommendations for most antiepileptic drugs for established, refractory, and
super-refractory SE. Limiting the methodologic heterogeneity across studies is
required and high-class randomized, controlled trials to inform clinicians about
the best treatment in established and refractory status are needed.
|Anesthetics/therapeutic use
[MESH]
|Anticonvulsants/adverse effects/*therapeutic use
[MESH]
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