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Treatment of Established Status Epilepticus

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 stat...

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Autores principales: Falco-Walter, Jessica J., Bleck, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882478/
https://www.ncbi.nlm.nih.gov/pubmed/27120626
http://dx.doi.org/10.3390/jcm5050049
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author Falco-Walter, Jessica J.
Bleck, Thomas
author_facet Falco-Walter, Jessica J.
Bleck, Thomas
author_sort Falco-Walter, Jessica J.
collection PubMed
description 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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spelling pubmed-48824782016-05-27 Treatment of Established Status Epilepticus Falco-Walter, Jessica J. Bleck, Thomas J Clin Med Review 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. MDPI 2016-04-25 /pmc/articles/PMC4882478/ /pubmed/27120626 http://dx.doi.org/10.3390/jcm5050049 Text en © 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Falco-Walter, Jessica J.
Bleck, Thomas
Treatment of Established Status Epilepticus
title Treatment of Established Status Epilepticus
title_full Treatment of Established Status Epilepticus
title_fullStr Treatment of Established Status Epilepticus
title_full_unstemmed Treatment of Established Status Epilepticus
title_short Treatment of Established Status Epilepticus
title_sort treatment of established status epilepticus
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882478/
https://www.ncbi.nlm.nih.gov/pubmed/27120626
http://dx.doi.org/10.3390/jcm5050049
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