Management of status epilepticus in patients with liver or kidney disease: a narrative review

ABSTRACT

Introduction: Status epilepticus (SE) is a neurologic and medical emergency with significant related morbidity and mortality. Hepatic or renal dysfunction can considerably affect the pharmacokinetics of drugs used for SE through a variety of direct or indirect mechanisms.

Areas Covered: This review aims to focus on the therapeutic management of SE in patients with hepatic or renal impairment, highlighting drugs’ selection and dose changes that may be necessary due to altered drug metabolism and excretion. The references for this review were identified by searches of PubMed and Google Scholar until May 2020.

Expert opinion: According to literature evidence and clinical experience, in patients with renal disease, the authors suggest considering lorazepam as the drug of choice in pre-hospital and intra-hospital early-stage SE, phenytoin in definite SE, propofol in refractory or super-refractory SE. In patients with liver disease, the authors suggest the use of lorazepam as drug of choice in pre-hospital and intra-hospital early-stage SE, lacosamide in definite SE, propofol in refractory or super-refractory SE. A list of preferred drugs for all SE stages is provided.

KEYWORDS:

• Renal impairment
• hepatic failure
• recurrent seizures
• epilepsy
• refractory

Article highlights

• Status epilepticus (SE) is a neurological and medical emergency with high morbidity and mortality

• Management of SE in patients with liver or kidney disease is complex, requiring great confidence with pharmacodynamics and pharmacokinetics of AEDs and anaesthetic drugs

• Due to the lack of clinical trials, management is mainly based on small case series and opinions

• In patients with liver disease, the authors suggest lorazepam as drug of choice in pre-hospital and intra-hospital SE, LCM in definite SE, propofol in refractory or super-refractory SE

• In patients with renal disease, the authors suggest lorazepam as the drug of choice in pre-hospital and intra-hospital SE, PHT in definite SE, propofol in refractory or super-refractory SE

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.