Problems and controversies in status epilepticus: a review and recommendations

Abstract

Status epilepticus (SE) is a neurologic emergency that require immediate vigorous treatment in order to prevent serious morbidity or even death. Several investigators have suggested that the underlying etiology is the primary determinant of outcome. We believe that this may be true in aggressively treated SE, but not when the treatment is less than optimal. In this article, we will discuss the factors that have been implicated in affecting SE outcomes, and argue, on the basis of both human and experimental animal data, that aggressive treatment is necessary and appropriate for all presentations of SE in order to maximize the probability of a successful outcome even when the etiology suggests a poor prognosis.

Keywords::

• etiology
• intravenous general anesthesia
• outcome
• prognosis
• status epilepticus
• treatment

Financial & competing interests disclosure

DM Treiman has received research support and/or has served as a consultant, on advisory boards and/or on a speakers’ bureau for a number of pharmaceutical companies, including manufacturers of drugs discussed in this review: Abbott Laboratories, Hoffmann-La Roche, Ortho-McNeil, Pfizer and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Reproduced with permission from [127].

AED: Antiepileptic drugs; iv.: Intravenous; LCM: Lacosamide; LEV: Levetiracetam; PB: Phenobarbital; PE: Phenytoin equivalent; PHT: Phenytoin; SE: Status epilepticus; VPA: Valproic acid.

Modified with permission from [127].