Status epilepticus - Time is brain and treatment considerations

Caroline Der-Nigoghossian, Clio Rubinos, Ayham Alkhachroum, Jan Claassen

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations

Abstract

Purpose of reviewStatus epilepticus is a neurological emergency associated with high morbidity and mortality. There is a lack of robust data to guide the management of this neurological emergency beyond the initial treatment. This review examines recent literature on treatment considerations including the choice of continuous anesthetics or adjunctive anticonvulsant, the cause of the status epilepticus, and use of nonpharmacologic therapies.Recent findingsStatus epilepticus remains undertreated and mortality persists to be unchanged over the past 30 years. New anticonvulsant choices, such as levetiracetam and lacosamide have been explored as alternative emergent therapies. Anecdotal reports on the use of other generation anticonvulsants and nonpharmacologic therapies for the treatment of refractory and super-refractory status epilepticus have been described.Finally, recent evidence has examined etiology-guided management of status epilepticus in certain patient populations, such as immune-mediated, paraneoplastic or infectious encephalitis and anoxic brain injury.SummaryRandomized clinical trials are needed to determine the role for newer generation anticonvulsants and nonpharmacologic modalities for the treatment of epilepticus remains and evaluate the long-term outcomes associated with continuous anesthetics.

Original languageEnglish (US)
Pages (from-to)638-646
Number of pages9
JournalCurrent Opinion in Critical Care
Volume25
Issue number6
DOIs
StatePublished - Dec 1 2019
Externally publishedYes

Keywords

  • anticonvulsants
  • continuous anesthetics
  • continuous electroencephalography
  • refractory status epilepticus
  • status epilepticus

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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