Original Article

Neurocritical Care

, Volume 18, Issue 2, pp 193-200

Treatment of Status Epilepticus: An International Survey of Experts

  • James J. RivielloJr.Affiliated withNYU Comprehensive Epilepsy Center, NYU Langone Medical Center, Division of Pediatric Neurology, Department of Neurology, New York University School of Medicine Email author 
  • , Jan ClaassenAffiliated withColumbia University
  • , Suzette M. LaRocheAffiliated withEmory University
  • , Michael R. SperlingAffiliated withThomas Jefferson University
  • , Brian AlldredgeAffiliated withUniversity of California
  • , Thomas P. BleckAffiliated withRush University Medical Center
  • , Tracy GlauserAffiliated withCincinnati Children’s Hospital Medical Center
  • , Lori ShutterAffiliated withUniversity of Cincinnati Medical Center
  • , David M. TreimanAffiliated withArizona State University
    • , Paul M. VespaAffiliated withNYU Comprehensive Epilepsy Center, NYU Langone Medical Center, Division of Pediatric Neurology, Department of Neurology, New York University School of MedicineUniversity of California
    • , Rodney BellAffiliated withThomas Jefferson University
    • , Gretchen M. BrophyAffiliated withNYU Comprehensive Epilepsy Center, NYU Langone Medical Center, Division of Pediatric Neurology, Department of Neurology, New York University School of MedicineVirginia Commonwealth University
    • , The Neurocritical Care Society Status Epilepticus Guideline Writing Committee

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Abstract

Background

As part of the development of the Neurocritical Care Society (NCS) Status Epilepticus (SE) Guidelines, the NCS SE Writing Committee conducted an international survey of SE experts.

Methods

The survey consisted of three patient vignettes (case 1, an adult; case 2, an adolescent; case 3, a child) and questions regarding treatment. The questions for each case focused on initial and sequential therapy as well as when to use continuous intravenous (cIV) therapy and for what duration. Responses were obtained from 60/120 (50%) of those surveyed.

Results

This survey reveals that there is expert consensus for using intravenous lorazepam for the emergent (first-line) therapy of SE in children and adults. For urgent (second-line) therapy, the most common agents chosen were phenytoin/fosphenytoin, valproate sodium, and levetiracetam; these choices varied by the patient age in the case scenarios. Physicians who care for adult patients chose cIV therapy for RSE, especially midazolam and propofol, rather than a standard AED sooner than those who care for children; and in children, there is a reluctance to choose propofol. Pentobarbital was chosen later in the therapy for all ages.

Conclusion

There is close agreement between the recently published NCS guideline for SE and this survey of experts in the treatment of SE.

Keywords

Status epilepticus Seizure Survey Antiepileptic treatment