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Evaluation and Treatment of Adult Status Epilepticus in the Emergency Department

  • Neurologic Emergencies (J Miller, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review summarizes the current knowledge and evidence behind the diagnosis and management of adult status epilepticus (SE) in the Emergency Department (ED). It incorporates the most recent evidence-based diagnostic and management strategies, while reflecting them back onto the foundational aspects of SE care.

Recent Findings

Recent studies have re-emphasized the importance of early and appropriately dosed benzodiazepines as first-line therapy for SE. Second-line therapy has evolved from phenytoin to alternative anti-epileptics (AEDs) like levetiracetam. Additionally, cerebral perfusion-computed tomography (PCT) and electroencephalogram (EEG) are critical in the diagnosis of non-convulsive SE (NCSE) in the ED.

Summary

Early and aggressive medical management is crucial to curb the morbidity and mortality of adult SE in the ED starting with benzodiazepines and progressing to AEDs. Patients who remain altered after treatment may still have NCSE. Due to the clinical subtleties associated with NCSE, it is essential to utilize tools such as alternative EEG monitoring and PCT.

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Authors and Affiliations

  1. Department of Emergency Medicine, Henry Ford Health, 2799 W. Grand Blvd, CFP 253, Detroit, MI, 48202, USA

    Reba John, Daniel Grahf, Arion Lochner, Ross Taylor, Seth Krupp & Taher Vohra

  2. Department of Internal Medicine, Henry Ford Health, Detroit, MI, USA

    Daniel Grahf

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Reba John, Daniel Grahf, Arion Lochner, Ross Taylor, Seth Krupp and Taher Vohra declare that they have no conflict of interest.

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John, R., Grahf, D., Lochner, A. et al. Evaluation and Treatment of Adult Status Epilepticus in the Emergency Department. Curr Emerg Hosp Med Rep 10, 107–115 (2022). https://doi.org/10.1007/s40138-022-00250-3

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