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Medical management of status epilepticus: Emergency room to intensive care unit.

Crawshaw, AA; Cock, HR (2020) Medical management of status epilepticus: Emergency room to intensive care unit. Seizure, 75. pp. 145-152. ISSN 1532-2688 https://doi.org/10.1016/j.seizure.2019.10.006
SGUL Authors: Cock, Hannah Rutherford

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Abstract

In convulsive status epilepticus (SE), achieving seizure control within the first 1-2 hours after onset is a significant determinant of outcome. Treatment is also more likely to work and be cost effective the earlier it is given. Initial first aid measures should be accompanied by establishing intravenous access if possible and administering thiamine and glucose if required. Calling for help will support efficient management, and also the potential for video-recording the events. This can be done as a best interests investigation to inform later management, provided adequate steps to protect data are taken. There is high quality evidence supporting the use of benzodiazepines for initial treatment. Midazolam (buccal, intranasal or intramuscular) has the most evidence where there is no intravenous access, with the practical advantages of administration outweighing the slightly slower onset of action. Either lorazepam or diazepam are suitable IV agents. Speed of administration and adequate initial dosing are probably more important than choice of drug. Although only phenytoin (and its prodrug fosphenytoin) and phenobarbitone are licensed for established SE, a now considerable body of evidence and international consensus supports the utility of both levetiracetam and valproate as options in established status. Both also have the advantage of being well tolerated as maintenance treatment, and possibly a lower risk of serious adverse events. Two adequately powered randomized open studies in children have recently reported, supporting the use of levetiracetam as an alterantive to phenytoin. The results of a large double blind study also including valproate are also imminent, and together likely to change practice in benzodiazepine-resistant SE.

Item Type: Article
Additional Information: © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Benzodiazepines, Levetiracetam, Phenytoin, Status epilepticus, Treatment, Valproate, Benzodiazepines, Levetiracetam, Phenytoin, Status epilepticus, Treatment, Valproate, Neurology & Neurosurgery, 1109 Neurosciences, 1103 Clinical Sciences, 1701 Psychology
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: Seizure
ISSN: 1532-2688
Language: eng
Dates:
DateEvent
February 2020Published
24 October 2019Published Online
8 October 2019Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
Projects:
Project IDFunderFunder ID
U01NS088034National Institute of Neurological Disorders and Strokehttp://dx.doi.org/10.13039/100000065
U01NS088023National Institute of Neurological Disorders and Strokehttp://dx.doi.org/10.13039/100000065
U01NS056975National Institute of Neurological Disorders and Strokehttp://dx.doi.org/10.13039/100000065
U01NS059041National Institute of Neurological Disorders and Strokehttp://dx.doi.org/10.13039/100000065
U01NS073476National Institute of Neurological Disorders and Strokehttp://dx.doi.org/10.13039/100000065
PubMed ID: 31722820
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111488
Publisher's version: https://doi.org/10.1016/j.seizure.2019.10.006

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