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CNS Drugs

, Volume 32, Issue 10, pp 891–893 | Cite as

Emergency First-Line Anti-Seizure Medication for Seizures and Status Epilepticus: What is Going Wrong, Doctor?

  • Raoul Sutter
Commentary
  • 98 Downloads

Repetitive and prolonged seizures as well as status epilepticus represent life-threatening neurologic emergencies with serious cerebral and systemic sequela [1]. High morbidity and mortality associated with untreated or uncontrolled seizures call for emergency treatment including airway management, hemodynamic and metabolic stabilization, protection from physical injuries, administration of emergency anti-seizure medication, and the identification and treatment of underlying pathologies. Despite the fact that randomized controlled trials in this context are mostly limited to first-line anti-seizure medication (i.e., benzodiazepines) [2, 3, 4, 5], international collaborations of experts including epileptologists, neurologists, neurointensivists, neurosurgeons, and pharmacologists led to the development of treatment guidelines for prolonged seizures and status epilepticus across the age spectrum [6, 7]. However, such guidelines focus on the in-hospital setting and, despite a number of...

Notes

Compliance with ethical standards

Funding

No funding was received for the preparation of this article.

Conflict of interest

Raoul Sutter received research Grants from the Swiss National Foundation (No. 320030_169379), the Research Fund of the University Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. He received personal grants from UCB-Pharma and holds stocks from Novartis and Roche.

References

  1. 1.
    Sutter R, Dittrich T, Semmlack S, Ruegg S, Marsch S, Kaplan PW. Acute systemic complications of convulsive status epilepticus: a systematic review. Crit Care Med. 2018;46(1):138–45.CrossRefPubMedGoogle Scholar
  2. 2.
    Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366(7):591–600.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Scott RC, Besag FM, Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet. 1999;353(9153):623–6.CrossRefPubMedGoogle Scholar
  4. 4.
    McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet. 2005;366(9481):205–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Ashrafi MR, Khosroshahi N, Karimi P, Malamiri RA, Bavarian B, Zarch AV, et al. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol. 2010;14(5):434–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48–61.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Semmlack S, Yeginsoy D, Spiegel R, Tisljar K, Ruegg S, Marsch S, et al. Emergency response to out-of-hospital status epilepticus: a 10-year observational cohort study. Neurology. 2017;89(4):376–84.CrossRefPubMedGoogle Scholar
  9. 9.
    Kadel J, Bauer S, Hermsen AM, Immisch I, Kay L, Klein KM, et al. Use of emergency medication in adult patients with epilepsy: a multicentre cohort study from Germany. CNS Drugs. 2018;32(8):771–81.CrossRefPubMedGoogle Scholar
  10. 10.
    Semmlack S, Tschudin-Sutter S, Widmer AF, Valenca M, Ruegg S, Marsch S, et al. Independent impact of infections on the course and outcome of status epilepticus: a 10-year cohort study. J Neurol. 2016;263(7):1303–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Sutter R, Tschudin-Sutter S, Grize L, Fuhr P, Bonten MJ, Widmer AF, et al. Associations between infections and clinical outcome parameters in status epilepticus: a retrospective 5-year cohort study. Epilepsia. 2012;53(9):1489–97.CrossRefPubMedGoogle Scholar
  12. 12.
    Zelano J, Moller F, Dobesberger J, Trinka E, Kumlien E. Infections in status epilepticus: a retrospective 5-year cohort study. Seizure. 2014;23(8):603–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Medical Intensive Care Units and Department of NeurologyUniversity Hospital BaselBaselSwitzerland
  2. 2.Medical FacultyUniversity of BaselBaselSwitzerland

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