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Pharmacy World and Science

, Volume 15, Supplement 1, pp 17–28 | Cite as

Generalized convulsive status epilepticus: Pathophysiology and treatment

  • Frans B. Scholtes
  • Willy O. Renier
  • Harry Meinardi
Pharmacotherapy Evaluations

Abstract

The treatment of generalized convulsive status epilepticus according to a protocol, including a time schedule, prevents unnecessary delay and improves outcome. Based on a literature study and our own clinical experiences a treatment protocol is discussed with special emphasis on medical complications, choice of antiepileptic drugs, route of administration and a proper time schedule.

Keywords

Anticonvulsants Clinical protocols Drug therapy Pathology Status epilepticus 

Keywords

Anticonvulsants Clinical protocols Drug therapy Pathology Status epilepticus 

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References

  1. 1.
    Gastaut H. A propos d'une classification symptomatologique des états de mal épileptiques. In: Gastaut H, Roger J, Lob H, eds. Les états de mal épileptiques. Paris: Masson, 1967:1–8.Google Scholar
  2. 2.
    Nevander G, Ingvar M, Auer R, Siesjo B. Irreversible neuronal damage after short periods of status epilepticus. Acta Physiol Scand 1984;120:155–7.PubMedGoogle Scholar
  3. 3.
    Nevander G, Ingvar M, Auer R, Siesjo B. Status epilepticus in well-oxygenated rats causes neuronal necrosis. Ann Neurol 1985;18:281–90.PubMedGoogle Scholar
  4. 4.
    Rowan A, Scott D. Major status epilepticus. Acta Neurol Scand 1970;46:573–84.PubMedGoogle Scholar
  5. 5.
    Heintel H. Der Status Epilepticus: seine Ätiologie, Klinik und Letalität. Stuttgart: Gustav Fischer Verlag, 1972.Google Scholar
  6. 6.
    Aminoff M, Simon R. Status epilepticus: causes, clinical features and consequenses in 98 patients. Am J Med 1980; 69:657–66.PubMedGoogle Scholar
  7. 7.
    Janz D. Etiology of convulsive status epilepticus. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:47–55.Google Scholar
  8. 8.
    Pilke A, Partinen M, Kovanen J. Status epilepticus and alcohol abuse. An analysis of 82 status epilepticus admissions. Acta Neurol Scand 1984;70:443–50.PubMedGoogle Scholar
  9. 9.
    Goulon M, Levy-Alcover M, Nouailhat F. État de mal épileptique de l'adulte. Étude épidemiologique et clinique en reanimation. Rev EEG Neurophysiol 1985;14:277–85.Google Scholar
  10. 10.
    Clark L, Prout T. Status epilepticus. A clinical and pathological study in epilepsy. Am J Insan 1903; 60:291–306, 645–75.Google Scholar
  11. 11.
    Whitty C, Taylor M. Treatment of status epilepticus. Lancet 1949;2:591–4.Google Scholar
  12. 12.
    Oxbury J, Whitty C. Causes and consequenses of status epilepticus in adults. A study of 86 cases. Brain 1971; 94:733–44.PubMedGoogle Scholar
  13. 13.
    Celesia G, Messert B, Murphy J. Status epilepticus of late adult onset. Neurology 1972; 22:1047–55.PubMedGoogle Scholar
  14. 14.
    Roger J, Lob H, Tassinari C. Status epilepticus. In: Vinken P, Bruyn G, eds. Handbook of clinical neurology. Vol. 15. The epilepsies. Amsterdam: Elsevier: 1974:145–88.Google Scholar
  15. 15.
    Celesia G. Prognosis in convulsive status epilepticus. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:55–61.Google Scholar
  16. 16.
    Sung C, Chu N. Status epilepticus in the elderly. Etiology, seizure type and outcome. Acta Neurol Scand 1989; 80:51–6.PubMedGoogle Scholar
  17. 17.
    Alldredge B, Lowenstein D, Simon R. Status epilepticus in the 1980s. Etiology, treatment and outcome [abstract]. Neurology 1990;40 Suppl 1:297.Google Scholar
  18. 18.
    Oxbury J, Whitty C. The syndrome of isolated status epilepticus. J Neurol Neurosurg Psychiatry 1971; 34:182–4.PubMedGoogle Scholar
  19. 19.
    Hunter R. Status epilepticus. History, incidence and problems. Epilepsia 1960;1:162–89.Google Scholar
  20. 20.
    Meldrum B. Metabolic factors during prolonged seizures and their relation to nerve cell death. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:261–77.Google Scholar
  21. 21.
    Glaser G. Medical complications of status epilepticus. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. Raven Press: 1983:395–9.Google Scholar
  22. 22.
    Simon R. Physiologic consequenses of status epilepticus. Epilepsia;26 Suppl 1:S58–66.Google Scholar
  23. 23.
    Simon R. Management of status epilepticus. In: Pedley T, Meldrum B, eds. Recent advances in epilepsy. Vol. 2. Edinburgh: Livingstone, 1985:137–61.Google Scholar
  24. 24.
    Lothman E. The biochemical basis and pathophysiology of status epilepticus. Neurology 1990;40 Suppl 2:13–23.PubMedGoogle Scholar
  25. 25.
    Horton R, Meldrum B, Pedley T, McWilliam J. Regional cerebral blood flow in the rat during prolonged seizure activity. Brain Res 1980;192:399–412.PubMedGoogle Scholar
  26. 26.
    Kreisman N, Rosenthal M, LaManna J, Sick T. Cerebral oxygenation during recurrent seizures. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:231–41.Google Scholar
  27. 27.
    Young R, Yagel S, Gonya-Magee T. Physiologic and metabolic alterations associated with seizures in normoxic and asphyxiated neonatal dogs. Epilepsia 1984;25:569–74.PubMedGoogle Scholar
  28. 28.
    Gabor A, Brooks A, Scobey R, Parsons G. Intracranial pressure during epileptic seizures. Electroencephalogr Clin Neurophysiol 1984;57:497–506.PubMedGoogle Scholar
  29. 29.
    Siesjo B, Wieloch T. Epileptic brain damage. Pathophysiology and neurochemical pathology. In: Delgado-Escueta A, Ward A, Woodbury D, Porter R, eds. Advances in neurology. Vol. 44. New York: Raven Press, 1986:813–47.Google Scholar
  30. 30.
    Clark G. Role of excitatory amino acids in brain injury caused by hypoxia-ischemia, status epilepticus and hypoglycemia. Clin Perinatol 1989;16:459–75.PubMedGoogle Scholar
  31. 31.
    Siesjo B. Cerebral metabolism in hypoxia and ischemia. Therapeutic implications. In: Reinhart K, Eyrich K, eds. Clinical aspects of oxygen transport and tissue oxygenation. Berlin: Springer-Verlag, 1989:399–427.Google Scholar
  32. 32.
    Clifford D, Olney J, Benz A. Ketamine, phencyclidine and MK-801 protect against kainic acid-induced seizure-related brain damage. Epilepsia 1990;31:382–90.PubMedGoogle Scholar
  33. 33.
    Bertram E, Lothman E. NMDA receptor antagonists and limbic status epilepticus: a comparison with standard anticonvulsants. Epilepsy Res 1990;5:177–84.PubMedGoogle Scholar
  34. 34.
    Delgado-Escueta A, Bajorek J. Status epilepticus. Mechanisms of brain damage and rational management. Epilepsia 1982;23 Suppl 1:S29–41.PubMedGoogle Scholar
  35. 35.
    Leppik I. Status epilepticus. Neurol Clin 1986;4:633–44.PubMedGoogle Scholar
  36. 36.
    Treiman D. Pharmacokinetics and clinical use of benzodiazepines in the management of status epilepticus. Epilepsia 1989; 30 Suppl 2:S4–10.PubMedGoogle Scholar
  37. 37.
    Treiman D, Tyrrell E, Lee J, Ben-Menachem E, Nelson L, Weil M, Shields W, et al. Lorazepam versus phenytoin in the treatment of major motor status epilepticus. A preliminary report. Epilepsia 1983;24:520.Google Scholar
  38. 38.
    Lowenstein D, Aminoff M, Simon R. Barbiturate anesthesia in the treatment of status epilepticus. Clinical experience with 14 patients. Neurology 1988;38:395–400.PubMedGoogle Scholar
  39. 39.
    Walton N, Treiman D. Response of status epilepticus induced by lithium and pilocarpine to treatment with diazepam. Exp Neurol 1988;101:267–75.PubMedGoogle Scholar
  40. 40.
    Delgado-Escueta A, Enrile-Bascal F. Combination therapy for status epilepticus. Intravenous diazepam and phenytoin. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:477–87.Google Scholar
  41. 41.
    Mitchell W, Crawford T. Lorazepam is the treatment of choice for status epilepticus. J Epilepsy 1990; 3:7–10.Google Scholar
  42. 42.
    Graves N, Kriel R. Rectal administration of antiepileptic drugs in children. Pediatr Neurol 1987; 3:321–26.PubMedGoogle Scholar
  43. 43.
    Egli M, Albani C. Relief of status epilepticus after i.m. administration of the new short-acting benzodiazepine midazolam (Dormicum). In: 12th World Congress of Neurology, 1981, Kyoto/Japan. Amsterdam: Excerpta Medica, 1981:44:abstract 137. (International Congress Series 548.)Google Scholar
  44. 44.
    Galvin G, Jelinek G. Midazolam: an effective intravenous agent for seizure control. Arch Emergency Med 1987; 4:169–72.Google Scholar
  45. 45.
    Tassinari C, Daniele O, Michelucci R, Bureau M, Dravet C, Roger J. Benzodiazepines. Efficacy in status epilepticus. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:465–77.Google Scholar
  46. 46.
    Sorel L, Mechler L, Harmant J. Comparative trial of intravenous lorazepam and clonazepam in status epilepticus. Clin Ther 1981;4:326–36.PubMedGoogle Scholar
  47. 47.
    Leppik I, Derivan A, Homan R, Walker J, Ramsay R, Patrick B. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA 1983;249:1452–4.PubMedGoogle Scholar
  48. 48.
    Bulau P, Froscher W, Schuchard V, Kreiten K. Prospektive randomisierte Untersuchung zur Wirksamkeit von Clonazepam und Diazepam beim Petit mal-Status. Nervenarzt 1986;57:667–71.PubMedGoogle Scholar
  49. 49.
    Van der Kley BM. De stabiliteit van fenytoïnenatrium in infuusvloeistof [Stability of phenytoin sodium in infusion fluid]. Pharm Weekbl 1988;123:28–9.Google Scholar
  50. 50.
    Cloyd J, Gumnit R, McLain W. Status epilepticus. The role of intravenous phenytoin. JAMA 1980; 244:1479–82.PubMedGoogle Scholar
  51. 51.
    Walton N, Treiman D. Efficacy of ACC-9653 (a phenytoin prodrug) in experimental status epilepticus in the rat. Epilepsy Res 1990;5:165–8.PubMedGoogle Scholar
  52. 52.
    Walton N, Treiman D. Phenobarbital treatment of status epilepticus in a rodent model. Epilepsy Res 1989; 4:216–21.PubMedGoogle Scholar
  53. 53.
    Goldberg M, McIntyre H. Barbiturates in the treatment of status epilepticus. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:499–505.Google Scholar
  54. 54.
    Shaner D, McCurdy S, Herring M, Gabor A. Treatment of status epilepticus. A prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology 1988;38:202–7.PubMedGoogle Scholar
  55. 55.
    Crawford T, Mitchell W, Fishman L, Snodgrass R. Very-highdose phenobarbital for refractory status epilepticus in children. Neurology 1988;38:1035–40.PubMedGoogle Scholar
  56. 56.
    Brown A, Horton J. Status epilepticus treated by intravenous infusions of thiopentone sodium. BMJ 1967; 1:27–8.PubMedGoogle Scholar
  57. 57.
    Orlowski J, Erenberg G, Lueders H, Cruse R. Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med 1984;12:367–73.PubMedGoogle Scholar
  58. 58.
    Osorio I, Reed R. Treatment of refractory generalized tonicclonic status epilepticus with pentobarbital anesthesia after high-dose phenytoin. Epilepsia 1989;30:464–71.PubMedGoogle Scholar
  59. 59.
    Ness P. Pentobarbital and EEG burst suppression in the treatment of status epilepticus refractory to benzodiazepines and phenytoin. Epilepsia 1990;31:61–7.PubMedGoogle Scholar
  60. 60.
    Laxenaire M, Tridon P, Poire P. Effect of chlormethiazole in treatment of delirium tremens and status epilepticus. Acta Psychiatr Scand 1966;42 Suppl 192:87–103.Google Scholar
  61. 61.
    Bentley G, Mellick R. Chlormethiazole in status epilepticus — three cases. Med J Aust 1975; 2:537–9.Google Scholar
  62. 62.
    Lingarn S, King J, Wilson J, Brett E, Marshall W. Chlormethiazole (Heminevrin) in status epilepticus in children. In: Dam M, Gram L, Penry J, eds. Advances in epileptology. XIIth Epilepsy International Symposium. New York: Raven Press, 1981:515–20.Google Scholar
  63. 63.
    Nouailhat F, Levy-Alcover M, Goulon M. Traitement de l'état de mal épileptique de l'adulte. Analyse retrospective de 192 cas traités en reanimation. Rev EEG Neurophysiol 1985;14:287–92.Google Scholar
  64. 64.
    Browne T. Paraldehyde, chlormethiazole and lidocaine for treatment of status epilepticus. In: Delgado-Escueta A, Wasterlain C, Treiman D, Porter R, eds. Advances in neurology. Vol. 34. Status epilepticus. New York: Raven Press, 1983:509–19.Google Scholar
  65. 65.
    Pascual J, Sedano M, Polo J, Berciano J. Intravenous lidocaine for status epilepticus. Epilepsia 1988;29:584–9.PubMedGoogle Scholar
  66. 66.
    Simon R, Benowitz N, Culala S. Motor paralysis increases brain uptake of lidocaine during status epilepticus. Neurology 1984;34:384–7.PubMedGoogle Scholar
  67. 67.
    Starre P. Etomidat als schnellwirksame antiepileptische Substanz. In: Opitz A, Degen R, eds. Anasthesie bei zerebralen Krampfanfallen und Intensivtherapie des Status epilepticus. Erlangen: Perimed, 1980:205–9.Google Scholar
  68. 68.
    Yeoman P, Hutchinson A, Byrne A. Etomidate infusions for control of refractory status epilepticus. Intens Care Med 1989;15:255–9.Google Scholar
  69. 69.
    Grant I, Hutchinson G. Epileptiform seizures during prolonged etomidate sedation. Lancet 1983;2:511–2.Google Scholar
  70. 70.
    Nickel B, Schmickaly R. Gesteigerte Anfallsbereitschaft unter Etomidatelangzeitinfusion beim Delirium Tremens. Anaesthesist 1985;34:462–9.PubMedGoogle Scholar
  71. 71.
    Lampl Y, Eshel Y, Gilad R, Sarova-Pinchas I. Chloral hydrate in intractable status epilepticus. Ann Emergency Med 1990;19:674–7.Google Scholar
  72. 72.
    Kofke W, Young R, Davis P, Woelfel S, Gray L, Johnson D, Gelb A, et al. Isoflurane for refractory status epilepticus. A clinical series. Anaesthesiology 1989;71:653–9.Google Scholar
  73. 73.
    Munari C, Casaroli D, Matteuzzi G, Pacifico L. The use of althesin in drug-resistant status epilepticus. Epilepsia 1979;20:475–84.PubMedGoogle Scholar
  74. 74.
    Giroud M, Dumas R. Traitement des états de mal épileptique par le valproate de sodium. Neurophysiol Clin 1988;18:21–32.PubMedGoogle Scholar
  75. 75.
    Yanny H, Christmas D. Propofol infusions for status epilepticus. Anaesthesia 1988;43:514.Google Scholar
  76. 76.
    Thomas D, Morgan P. Propofol infusions for the treatment of status epilepticus. Todays Anaesthesist 1989; 4:106–7.Google Scholar
  77. 77.
    Mackenzie S, Kapadia F, Grant L. Propofol infusion for control of status epilepticus. Anaesthesia 1990;45:1043–5.PubMedGoogle Scholar
  78. 78.
    Van Dijk B, Bakker N, Brandsma G, De Jong G, Lange J. Epileptisch insult onmiddellijk na toediening van propofol [Epileptic seizure immediately following administration of propofol]. Ned Tijdschr Geneeskd 1991; 135:1452–3.PubMedGoogle Scholar
  79. 79.
    Franzoni E, Carboni C, Lambertini A. Rectal diazepam. A clinical and EEG study after a single dose in children. Epilepsia 1983, 24:35–41.PubMedGoogle Scholar
  80. 80.
    Lombroso C. Rectal diazepam. Epilepsia 1989;30 Suppl 2:S11–4.PubMedGoogle Scholar
  81. 81.
    Albert H. Midazolam bei der Behandlung des status epilepticus. In: Kugler J, Leutner V, eds. Benzodiazepine in der Neurologie. Grenzach: Editiones Roche, 1987:187–8.Google Scholar
  82. 82.
    Ghilain S, Rijckevorsel-Harmant K, Harmant J, Barsy T. Midazolam in the treatment of epileptic seizures. J Neurol Neurosurg Psychiatry 1988;51:732.Google Scholar
  83. 83.
    Benowitz N, Simon R, Copeland J. Status epilepticus. Divergence of sympathetic activity and cardio-vascular response. Ann Neurol 1986;19:197–9.PubMedGoogle Scholar
  84. 84.
    Leppik I, Jacobs M, Loewenson R, Hauser W, Micks M, Taylor M. Alcohol and status epilepticus. In: Porter R, Mattson R, Cramer J, Diamond I, Schoenberg D, eds. Alcohol and seizures. Philadelphia: F.A. Davis Company, 1990:216–21.Google Scholar
  85. 85.
    Malouf R. Hypoglycaemia: causes, neurological manifestations and outcome. Ann Neurol 1985;17:421–30.PubMedGoogle Scholar
  86. 86.
    Bergsholm P, Gran L, Bleie H. Seizure duration in unilateral electroconvulsive therapy. The effect of hypocapnia induced by hyperventilation and the effect of ventilation with oxygen. Acta Psychiatr Scand 1984;69:121–8.PubMedGoogle Scholar

Copyright information

© Periodicals Service Company 1993

Authors and Affiliations

  • Frans B. Scholtes
    • 1
  • Willy O. Renier
    • 2
  • Harry Meinardi
    • 2
  1. 1.Dr. Hans Berger ClinicRA Bredathe Netherlands
  2. 2.University Hospital NijmegenHB Nijmegenthe Netherlands

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