Treatment of established status epilepticus

Jessica J. Falco-Walter*, Thomas Bleck

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations

Abstract

Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE.

Original languageEnglish (US)
Article number49
JournalJournal of Clinical Medicine
Volume5
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

Keywords

  • Antiseizure
  • Established status epilepticus
  • Lacosamide
  • Levetiracetam
  • Phenobarbital
  • Phenytoin
  • Status epilepticus
  • Treatment
  • Valproic acid

ASJC Scopus subject areas

  • Medicine(all)

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