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Treatment of Status Epilepticus: An International Survey of Experts

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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.

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Authors and Affiliations

  1. NYU Comprehensive Epilepsy Center, NYU Langone Medical Center, Division of Pediatric Neurology, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY, 10016, USA

    James J. Riviello Jr.

  2. Columbia University, New York, NY, USA

    Jan Claassen

  3. Emory University, Altanta, GA, USA

    Suzette M. LaRoche

  4. Thomas Jefferson University, Philadelphia, PA, USA

    Michael R. Sperling & Rodney Bell

  5. University of California, San Francisco, CA, USA

    Brian Alldredge

  6. Rush University Medical Center, Chicago, IL, USA

    Thomas P. Bleck

  7. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Tracy Glauser

  8. University of Cincinnati Medical Center, Cincinnati, OH, USA

    Lori Shutter

  9. Arizona State University, Tempe, AZ, USA

    David M. Treiman

  10. University of California, Los Angeles, CA, USA

    Paul M. Vespa

  11. Virginia Commonwealth University, Richmond, VA, USA

    Gretchen M. Brophy

Authors
  1. James J. Riviello Jr.
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  2. Jan Claassen
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  3. Suzette M. LaRoche
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  4. Michael R. Sperling
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  5. Brian Alldredge
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  6. Thomas P. Bleck
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  7. Tracy Glauser
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  8. Lori Shutter
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  9. David M. Treiman
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  10. Paul M. Vespa
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  11. Rodney Bell
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  12. Gretchen M. Brophy
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Consortia

The Neurocritical Care Society Status Epilepticus Guideline Writing Committee

Corresponding author

Correspondence to James J. Riviello Jr..

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Riviello, J.J., Claassen, J., LaRoche, S.M. et al. Treatment of Status Epilepticus: An International Survey of Experts. Neurocrit Care 18, 193–200 (2013). https://doi.org/10.1007/s12028-012-9790-1

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  • DOI: https://doi.org/10.1007/s12028-012-9790-1

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