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Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence

BACKGROUND: Convulsive status epilepticus is the most severe form of epilepsy and requires urgent treatment. We synthesised the current evidence on first-line treatments for controlling seizures in adults with convulsive status epilepticus before, or at, arrival at hospital. METHODS: We conducted a...

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Autores principales: Cruickshank, Moira, Imamura, Mari, Counsell, Carl, Aucott, Lorna, Manson, Paul, Booth, Corinne, Scotland, Graham, Brazzelli, Miriam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9217864/
https://www.ncbi.nlm.nih.gov/pubmed/35094154
http://dx.doi.org/10.1007/s00415-022-10979-2
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author Cruickshank, Moira
Imamura, Mari
Counsell, Carl
Aucott, Lorna
Manson, Paul
Booth, Corinne
Scotland, Graham
Brazzelli, Miriam
author_facet Cruickshank, Moira
Imamura, Mari
Counsell, Carl
Aucott, Lorna
Manson, Paul
Booth, Corinne
Scotland, Graham
Brazzelli, Miriam
author_sort Cruickshank, Moira
collection PubMed
description BACKGROUND: Convulsive status epilepticus is the most severe form of epilepsy and requires urgent treatment. We synthesised the current evidence on first-line treatments for controlling seizures in adults with convulsive status epilepticus before, or at, arrival at hospital. METHODS: We conducted a systematic review of randomised controlled trials (RCTs) assessing antiepileptic drugs offered to adults as first-line treatments. Major electronic databases were searched. RESULTS: Four RCTs (1234 adults) were included. None were conducted in the UK and none assessed the use of buccal or intranasal midazolam. Both intravenous lorazepam and intravenous diazepam administered by paramedics were more effective than placebo and, notably, intramuscular midazolam was non-inferior to intravenous lorazepam. Overall, median time to seizure cessation from drug administration varied from 2 to 15 min. Rates of respiratory depression among participants receiving active treatments ranged from 6.4 to 10.6%. Mortality ranged from 2 to 7.6% in active treatment groups and 6.2 to 15.5% in control groups. CONCLUSIONS: Intravenous and intramuscular benzodiazepines are safe and effective in this clinical context. Further research is needed to establish the most clinically and cost-effective first-line treatment and preferable mode of administration. Head-to-head trials comparing buccal versus intranasal midazolam versus rectal diazepam would provide useful information to inform the management of the first stage of convulsive status epilepticus in adults, especially when intravenous or intramuscular access is not feasible. Approaches to improve adherence to clinical guidelines on the use of currently available benzodiazepines for the first-line treatment of convulsive status epilepticus should also be considered.
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spelling pubmed-92178642022-06-24 Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence Cruickshank, Moira Imamura, Mari Counsell, Carl Aucott, Lorna Manson, Paul Booth, Corinne Scotland, Graham Brazzelli, Miriam J Neurol Review BACKGROUND: Convulsive status epilepticus is the most severe form of epilepsy and requires urgent treatment. We synthesised the current evidence on first-line treatments for controlling seizures in adults with convulsive status epilepticus before, or at, arrival at hospital. METHODS: We conducted a systematic review of randomised controlled trials (RCTs) assessing antiepileptic drugs offered to adults as first-line treatments. Major electronic databases were searched. RESULTS: Four RCTs (1234 adults) were included. None were conducted in the UK and none assessed the use of buccal or intranasal midazolam. Both intravenous lorazepam and intravenous diazepam administered by paramedics were more effective than placebo and, notably, intramuscular midazolam was non-inferior to intravenous lorazepam. Overall, median time to seizure cessation from drug administration varied from 2 to 15 min. Rates of respiratory depression among participants receiving active treatments ranged from 6.4 to 10.6%. Mortality ranged from 2 to 7.6% in active treatment groups and 6.2 to 15.5% in control groups. CONCLUSIONS: Intravenous and intramuscular benzodiazepines are safe and effective in this clinical context. Further research is needed to establish the most clinically and cost-effective first-line treatment and preferable mode of administration. Head-to-head trials comparing buccal versus intranasal midazolam versus rectal diazepam would provide useful information to inform the management of the first stage of convulsive status epilepticus in adults, especially when intravenous or intramuscular access is not feasible. Approaches to improve adherence to clinical guidelines on the use of currently available benzodiazepines for the first-line treatment of convulsive status epilepticus should also be considered. Springer Berlin Heidelberg 2022-01-30 2022 /pmc/articles/PMC9217864/ /pubmed/35094154 http://dx.doi.org/10.1007/s00415-022-10979-2 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review
Cruickshank, Moira
Imamura, Mari
Counsell, Carl
Aucott, Lorna
Manson, Paul
Booth, Corinne
Scotland, Graham
Brazzelli, Miriam
Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence
title Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence
title_full Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence
title_fullStr Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence
title_full_unstemmed Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence
title_short Management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence
title_sort management of the first stage of convulsive status epilepticus in adults: a systematic review of current randomised evidence
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9217864/
https://www.ncbi.nlm.nih.gov/pubmed/35094154
http://dx.doi.org/10.1007/s00415-022-10979-2
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