Abstract

Review Article

Critical Management of Status Epilepticus

Farahnaz Fallahian* and Seyed MohammadReza Hashemian*

Published: 14 March, 2017 | Volume 2 - Issue 1 | Pages: 001-015

Seizure is clinical manifestation of sudden disruption of the normal electrical activity of cortical neurons. The brain electrical activity is periodically disturbed, alteration in neural cell integrity, increase in firing impulses and spread to adjacent normal neurons result in temporary brain dysfunction with alterations in consciousness, behavior or motor function. It may be triggered by illness, infection, stress, stroke, brain tumor, or the underlying cause may not completely understand. Status epilepticus (SE) is a medical emergency and requires prompt diagnosis and treatment. Treatment includes general support measures, drugs to suppress epileptic activity and relieving the underlying condition. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. For SE treatment, benzodiazepines are the first line antiepileptic agents, and if benzodiazepines fail to control seizures, Phenytoin is usually indicated; Phenobarbital or Valproate may also be considered. For refractory SE, Propofol and Thiopental represent first line agents after careful assessment of potential risks. In refractory SE, general anesthesia may be required. There is currently no unique consensus for definite treatment option of RSE. In this review, the management protocol of seizure, assessment, monitoring, and different alternative therapy would be discussed.

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001004 Cite this Article Read Full Article PDF

Keywords:

Status epilepticus; Refractory status epilepticus; Nonconvulsive seizure; Pharmacotherapy algorithms

References

  1. Behera MK, Rana KS, Kanitkar M, Adhikari KM. Status Epilepticus in Children. Med J Armed Forces India. 2005; 61: 174-178. Ref.: https://goo.gl/alP7Fp
  2. Singhi S, Singhi P, Dass R. Status epilepticus: Emergency management. Indian J Pediatr. 2003; 70; 1: S1-22. Ref.: https://goo.gl/lIvnEc
  3. Gulati S, Vasudevan A. Status epilepticus. In: Suraj Gupte, editor. Text Book of Pediatric Emergencies. New Delhi: Peepee Publishers and Distributors. 2004; 134-141.
  4. Chin RF, Verhulst L, Neville BG, Peters MJ, Scott RC. Inappropriate emergency management of Status epilepticus in children contributes a need for intensive care. J Neurol Neurosurg Psychiatry. 2004; 75: 1584-1588. Ref.: https://goo.gl/1Qqz7U
  5. Gratrix AP, Simon M Enright. Epilepsy in anaesthesia and intensive care. Contin Educ Anaesth Crit Care Pain. 2005; 5: 118-121. Ref.: https://goo.gl/6pLQch
  6. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998; 339: 792-798. Ref.: https://goo.gl/6qo4Ho
  7. Abou Khaled KJ, Hirsch LJ. Updates in the management of seizures and status epilepticus in critically ill patients. Neurol Clin. 2008; 26: 385-408. Ref.: https://goo.gl/DBKrXc
  8. Bhagat H, Dash HH. Anaesthesiologist’s role in the management of an epileptic patient. Indian J. Anaesth. 2006; 50: 20-26. Ref.: https://goo.gl/17uwFS
  9. Treiman DM. Status epilepticus. In: Laidlaw J, Richens A, Chadwick D, editors: A textbook of epilepsy. New York, Churchill Livingstone 1993: 205.
  10. Lowenstein DH, Alldredge BK. Status epilepticus. N Eng J Med. 1998; 338: 970-976. Ref.: https://goo.gl/gRA6bo
  11. Treiman DM. Treatment of status epilepticus. In: Engel Jr J, Pedley TA editors: Epilepsy: A comprehensive textbook. Philadelphia: Lippincott-Raven. 1997; 1317-1323.
  12. Shorvon S. Status Epilepticus: Its Clinical Features and Treatment in Children and Adults. Cambridge, England: Cambridge University Press. 1994; 201. Ref.: https://goo.gl/b73xeA
  13. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, midazolam: a systemic review. Epilepsia. 2002; 43: 146-153. Ref.: https://goo.gl/k4cnBr
  14. Mayer SA, Claassen J, Lokin J, Mendesohn F, Dennis LJ, et al. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol. 2002; 59: 205-210. Ref.: https://goo.gl/PwpVS6
  15. Friedman D, Claassen J, Hirsch LJ. Continuous Electroencephalogram Monitoring in the Intensive Care Unit. Anesth Analg. 2009; 109: 506-523. Ref.: https://goo.gl/VTY7Es
  16. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004; 62: 1743-1748. Ref.: https://goo.gl/5SyQ4w
  17. DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998; 39: 833-840. Ref.: https://goo.gl/Jt4VnZ
  18. Walker M, Cross H, Smith S, Young C, Aicardi J, et al. Nonconvulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord. 2005; 7: 253-296. Ref.: https://goo.gl/cJh2AP
  19. Patsalos PN, Fröscher W, Pisani F, van Rijn CM. The importance of drug interactions in epilepsy therapy. Epilepsia. 2002; 43: 365-385. Ref.: https://goo.gl/aDaerp
  20. Velisek L, Nebieridze N, Chachua T, Veliskova J. Anti-seizure medications and estradiol for neuroprotection in epilepsy: the 2013 update. Recent Pat CNS Drug Discov. 2013; 8: 24-41. Ref.: https://goo.gl/mBfLfg
  21. Finsterer J. Toxicity of Antiepileptic Drugs to Mitochondria. Handb Exp Pharmacol. 2016 Sep 3. Ref.: https://goo.gl/zYnUOz
  22. Stephen LJ. Drug treatment of epilepsy in elderly people: focus on valproic Acid. Drugs Aging. 2003; 20: 141-152. Ref.: https://goo.gl/etP0Qm
  23. Al-Quteimat OM. Phenytoin-induced toxic epidermal necrolysis: Review and recommendations. J Pharmacol Pharmacother. 2016; 7: 127-132. Ref.: https://goo.gl/PuuUXy
  24. Leppik IE, Derivan AT, Homan RW, Walker J, Ramsay RE, et al. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA. 1983; 249: 1452-1454. Ref.: https://goo.gl/jBM1rk
  25. Alvarez V, Januel JM, Burnand B, Rossetti AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011; 52: 1292-1296. Ref.: https://goo.gl/73Vv09
  26. Gilad R, Izkovitz N, Dabby R, Rapoport A, Sadeh M, et al. Treatment of status epilepticus and acute repetitive seizures with i.v. valproic acid vs phenytoin. Acta Neurol Scand. 2008; 118: 296-300. Ref.: https://goo.gl/z69fP4
  27. Lawn ND, Wijdicks EFM. Status epilepticus: A critical review of management Options. Can J Neurol Sci. 2002; 7: 47-59. Ref.: https://goo.gl/znppHj
  28. Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001; 345: 631-637. Ref.: https://goo.gl/55M3QS
  29. WE Dodson, RJ DeLorenzo, TA Pedley. Working Group on Status Epilepticus. Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s working group on status epilepticus. JAMA. 1993; 270: 854-859.
  30. Osorio I, Reed RC. Treatment of refractory generalized tonic-clonic status epilepticus with pentobarbital anesthesia after high-dose phenytoin. Epilepsia. 1989; 30: 464-471. Ref.: https://goo.gl/iAGv7j
  31. Lowenstein DH, Aminoff MJ, Simon RP. Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. Neurology 1988; 38: 395-400. Ref.: https://goo.gl/NNAL1i
  32. Yaffe K, Lowenstein DH. Prognostic factors of pentobarbital therapy for refractory generalized status epilepticus. Neurology. 1993; 43: 895-900. Ref.: https://goo.gl/IOyyGC
  33. Shorvon S. Status epilepticus: its clinical features and treatment in children and adults. Cambridge, England: Cambridge University Press, 1994. Ref.: https://goo.gl/gnqT9X
  34. Moudgill GC. Update on anaesthesia and the immune response. Can Anaesth Soc J. 1986; 33: S54-S60. Ref.: https://goo.gl/eoS62I
  35. Kinoshita H, Nakagawa E, Iwasaki Y, Hanaoka S, Sugai K. Pentobarbital therapy for status epilepticus in children: timing of tapering. Pediatr Neurol. 1995; 13: 164-168. Ref.: https://goo.gl/tlMD1m
  36. Sheth RD, Gidal BE. Refractory status epilepticus: response to ketamine. Neurology. 1998; 51: 1765-1766. Ref.: https://goo.gl/6Pa0Fq
  37. com http://lifeinthefastlane.com/2010/10/ebm-status-epilepticus/Status Epilepticus EBM Review October 31, 2010 By Mike Cadogan. Ref.: https://goo.gl/CNwIY5
  38. Costello DJ, Cole AJ. Treatment of acute seizures and status epilepticus. J Intensive Care Med. 2007; 22: 319-47. Ref.: https://goo.gl/CpF2aE
  39. Chapman MG, Smith M, Hirsch NP. Status epilepticus. Anaesthesia. 2001; 56: 648-659. Ref.: https://goo.gl/BIv50K
  40. Treiman DM, Convulsive status epilepticus. Curr Treat Options Neurol. 1999; 1: 359-369. Ref.: https://goo.gl/euvGNh
  41. Marik PE, Varon J. The Management of Status Epilepticus. Chest. 2004; 126: 582-591. Ref.: https://goo.gl/wcMrBW
  42. Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001; 345: 631-637. Ref.: https://goo.gl/HUhXa2
  43. Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med. 1998; 338: 970-976. Ref.: https://goo.gl/m83Obh
  44. DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998; 39: 833-840. Ref.: https://goo.gl/QMPAZ0
  45. Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000; 54: 340-345. Ref.: https://goo.gl/5qFVBG
  46. Celesia G. Modern concepts of status epilepticus. JAMA. 1976; 235:1571-1574. Ref.: https://goo.gl/SsyGCi
  47. Dunne JW, Summers QA, Stewart-Wynne EG. Non-convulsive status epilepticus: a prospective study in an adult general hospital. Q J Med. 1987; 62: 117-126. Ref.: https://goo.gl/eFYQGB
  48. Rossetti AO, Reichhart MD, Schaller MD, Despland PA, Bogousslavsky J. Propofol Treatment of Refractory Status Epilepticus: A Study of 31 Episodes. Epilepsia. 2004; 45: 757-763. Ref.: https://goo.gl/nr5gxu
  49. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, et al. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol. 2002; 59: 205-210. Ref.: https://goo.gl/9OvWyo
  50. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002; 43: 146-153. Ref.: https://goo.gl/efFyzH
  51. Smith I, White PF, Nathanson M, Gouldson R. Propofol: an update on its clinical use. Anesthesiology. 1994; 81: 1005-1043. Ref.: https://goo.gl/K3jOIX
  52. Hara M, Kai Y, Ikemoto Y. Propofol activates GABAA receptor-chloride ionophore complex in dissociated hippocampal pyramidal neurons of the rat. Anesthesiology. 1993; 79: 781-788. Ref.: https://goo.gl/uc8vMM
  53. Orser BA, Bertlik M, Wang LY, JF MacDonald. Inhibition by propofol (2,6 di-isopropylphenol) of the N-methyl-D-aspartate subtype of glutamate receptor in cultured hippocampal neurones. Br J Pharmacol. 1995; 116: 1761-1768. Ref.: https://goo.gl/adVxBm
  54. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med. 2003; 29: 1417-1425. Ref.: https://goo.gl/LZWe0l
  55. Parke TJ, Stevens JE, Rice AS, CL Greenaway, RJ Bray, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ. 1992; 305: 613-616. Ref.: https://goo.gl/8g46d6
  56. Kang TM. Propofol infusion syndrome in critically ill patients. Ann Pharmacother. 2002; 36: 1453-1456. Ref.: https://goo.gl/xzz2oz
  57. Shorvon S. The management of status epilepticus. J Neurol Neurosurg Psychiatry. 2001; 70: 22-27. Ref.: https://goo.gl/JJEYZe
  58. Bassin S, Smith TL, Bleck TP. Clinical review: status epilepticus. Crit Care. 2002; 6: 137-142. Ref.: https://goo.gl/06dYCg
  59. Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland (EPISTAR). Neurology. 2000; 55: 693-697. Ref.: https://goo.gl/siIOFp
  60. Holtkamp M, Masuhr F, Harms L, K Einhaupl, H Meierkord, et al. The management of refractory generalised convulsive and complex partial status epilepticus in three European countries: a survey among epileptologists and critical care neurologists. J Neurol Neurosurg Psychiatry. 2003; 74: 1095-1099. Ref.: https://goo.gl/CqmT5l
  61. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, et at. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16: 48-61. Ref.: https://goo.gl/W2kUUt
  62. Szupera Z. [New antiepileptic drugs, and therapeutic considerations]. Ideggyogy Sz. 2011 Sep 30; 64(9-10):329-32.
  63. Pulman J, Hutton JL, Marson AG. Tiagabine add-on for drug-resistant partial epilepsy. Cochrane Database Syst Rev. 2012; 5: CD001908. Ref.: https://goo.gl/6g1CHt
  64. Stokes T, Shaw EJ, Juarez-Garcia A, Camosso-Stefinovic J, Baker R. Clinical Guidelines and Evidence Review for the Epilepsies: diagnosis and management in adults and children in primary and secondary care London: Royal College of General National Collaborating Centre for Primary Care. 2004.
  65. Simmons LE, Riker RR, Prato BS, Fraser GL. Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale. Crit Care Med. 1999; 27: 1499-504. Ref.: https://goo.gl/UeIxDH
  66. Prichep LS, Gugino LD, John ER, Chabot RJ, Howard B, et al. The Patient State Index as an indicator of the level of hypnosis under general anaesthesia. Br J Anaesth. 2004; 92: 393-399. Ref.: https://goo.gl/FbkbtR
  67. Bauerle K, Greim CA, Schroth M, Geisselbrecht M, Kobler A, et al. Prediction of depth of sedation and anesthesia by the Narcotrend EEG monitor. Br J Anaesth. 2004; 92: 841-845. Ref.: https://goo.gl/xMhEfF
  68. Roustan JP, Valette S, Aubas P, Rondouin G, Capdevila X. Can electroencephalographic analysis be used to determine sedation levels in critically ill patients? Anesth Analg. 2005; 101: 1141-1151. Ref.: https://goo.gl/7i6uFa
  69. Trinka E, Höfler J, Leitinger M, Brigo F. Pharmacotherapy for Status Epilepticus. Drugs. 2015; 75: 1499-1521. Ref.: https://goo.gl/cwlhin
  70. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011; 134: 2802-2818. Ref.: https://goo.gl/QyhDb9
  71. Trinka E, Kälviäinen R. 25 years of advances in definition, classification and treatment of status epilepticus. Seizure. 2017; 44: 65-73. Ref.: https://goo.gl/IvJo7N
  72. Fung EL, Fung BB; Subcommittee on the Consensus Statement of the Hong Kong Epilepsy Society. Review and update of the Hong Kong Epilepsy Guideline on status epilepticus. Hong Kong Med J. 2017; 23: 67-73. Ref.: https://goo.gl/8CPVHF
  73. Engel J Jr. What can we do for people with drug-resistant epilepsy? The 2016 Wartenberg Lecture. Neurology. 2016; 87: 2483-2489 . Ref.: https://goo.gl/dDv0Ht
  74. Logroscino G, Hesdorffer DC, Cascino G, Hauser WA, Coeytaux A, et al. Longterm mortality after a first episode of status epilepticus. Neurology. 2002; 58: 537-541. Ref.: https://goo.gl/qcGTFZ
  75. Jordan KG. Nonconvulsive status epilepticus in acute brain injury. J Clin Neurophysiol. 1999; 16: 332-340. Ref.: https://goo.gl/cxjNA6
  76. Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996; 47: 83-89. Ref.: https://goo.gl/0llLtY

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