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2016 ; 5
(5
): ä Nephropedia Template TP
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Treatment of Established Status Epilepticus
#MMPMID27120626
Falco-Walter JJ
; Bleck T
J Clin Med
2016[Apr]; 5
(5
): ä PMID27120626
show ga
Status epilepticus is the most severe form of epilepsy, with a high mortality
rate and high health care costs. Status epilepticus is divided into four stages:
early, established, refractory, and super-refractory. While initial treatment
with benzodiazepines has become standard of care for early status epilepticus,
treatment after benzodiazepine failure (established status epilepticus (ESE)) is
incompletely studied. Effective treatment of ESE is critical as morbidity and
mortality increases dramatically the longer convulsive status epilepticus
persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital,
and lacosamide are the most frequently prescribed antiseizure medications for
treatment of ESE. To date there are no class 1 data to support pharmacologic
recommendations of one agent over another. We review each of these medications,
their pharmacology, the scientific evidence in support and against each in the
available literature, adverse effects and safety profiles, dosing
recommendations, and limitations of the available evidence. We also discuss
future directions including the established status epilepticus treatment trial
(ESETT). Substantial further research is urgently needed to identify these
patients (particularly those with non-convulsive status epilepticus), elucidate
the most efficacious antiseizure treatment with head-to-head randomized
prospective trials, and determine whether this differs for convulsive vs.
non-convulsive ESE.
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