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Recent developments in the diagnosis and treatment of status epilepticus

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Abstract

Despite increased understanding of its potential complications, status epilepticus (SE) frequently remains difficult to diagnose and treat. Advances in continuous electroencephalogram (EEG) monitoring facilitate more rapid identification of SE, even without visible clinical signs of seizures. EEG monitoring assists in modifying SE treatment and in making a prognosis. Despite the improved recognition of SE, some patients continue to seize after treatment with intravenous benzodiazepines and other medications. There are new uses for valproic acid, levetiracetam, and topiramate, and they have evidence of efficacy in treating different forms of SE. If medical treatments do not terminate SE, other interventions, such as surgery and stimulation procedures, may promote seizure cessation. This article reviews recent studies evaluating the use of continuous EEG monitoring in the setting of SE, new uses of anticonvulsants, and nonpharmacologic interventions for SE.

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References and Recommended Reading

  1. Varelas PN, Spanaki MV, Hacein-Bey L, Terranova HT: Emergent EEG: indications and diagnostic yield. Neurology 2003, 61:702–704.

    PubMed  CAS  Google Scholar 

  2. Holtkamp M, Othman J, Buchheim K, et al.: A “malignant” variant of status epilepticus. Arch Neurol 2005, 62:1428–1431.

    Article  PubMed  Google Scholar 

  3. Bleck TP: Refractory status epilepticus in 2001. Arch Neurol 2002, 59:188–189.

    Article  PubMed  Google Scholar 

  4. Claassen J, Hirsch LJ, Emerson RG, Mayer SA: Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 2002, 43:146–153.

    Article  PubMed  CAS  Google Scholar 

  5. Litt B, Wityk RJ, Hertz SH, et al.: Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia 1998, 39:1194–1202.

    Article  PubMed  CAS  Google Scholar 

  6. Shorvon S: The concept of status epilepticus and its history. In Status Epilepticus: Its Clinical Features and Treatment in Children and Adults. Edited by Shorvon S. Cambridge: Cambridge University Press; 1994:1–20.

    Google Scholar 

  7. Claassen J, Mayer SA, Kowalski RG, et al.: Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004, 62:1743–1748.

    PubMed  CAS  Google Scholar 

  8. Towne AR, Waterhouse EJ, Boggs JG, et al.: Prevalence of nonconvulsive SE in comatose patients. Neurology 2000, 54:340–345.

    PubMed  CAS  Google Scholar 

  9. Jordan KG: Continuous EEG monitoring in the neuroscience intensive care unit and emergency department. J Clin Neurophysiol 1999, 16:14–39.

    Article  PubMed  CAS  Google Scholar 

  10. DeLorenzo RJ, Waterhouse EJ, Towne AR, et al.: Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998, 39:833–840.

    Article  PubMed  CAS  Google Scholar 

  11. Claassen J, Hirsch LJ, Emerson RG, et al.: Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology 2001, 57:1036–1042.

    PubMed  CAS  Google Scholar 

  12. Jette N, Claassen J, Emerson RG, Hirsch LJ: Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 2006, 63:1750–1755.

    Article  PubMed  Google Scholar 

  13. Tay SK, Hirsch LJ, Leary L, et al.: Nonconvulsive status epilepticus in children: clinical and EEG characteristics. Epilepsia 2006, 47:1504–1509.

    Article  PubMed  Google Scholar 

  14. Vespa PM, Nuwer MR, Nenov V, et al.: Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg 1999, 91:750–760.

    PubMed  CAS  Google Scholar 

  15. Vespa PM, O’Phelan K, Shah M, et al.: Acute seizures after intracerebral hemorrhage: A factor in progressive midline shift and outcome. Neurology 2003, 60:1441–1446.

    PubMed  CAS  Google Scholar 

  16. Trevathan E: Rapid EEG analysis for intensive care decisions in status epilepticus. Am J Med Technol 2006, 46:4–17.

    Google Scholar 

  17. Knake S, Rochon J, Fleischer S, et al.: Status epilepticus after stroke is associated with increased long-term case fatality. Epilepsia 2006, 47:2020–2026.

    Article  PubMed  Google Scholar 

  18. Rossetti AO, Hurwitz S, Logroscino G, Bromfield EB: Prognosis of status epilepticus: Role of aetiology, age, and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry 2006, 77:611–615.

    Article  PubMed  CAS  Google Scholar 

  19. Towne AR, Pellock JM, Ko D, DeLorenzo RJ: Determinants of mortality in status epilepticus. Epilepsia 1994, 35:27–34.

    Article  PubMed  CAS  Google Scholar 

  20. Jaitly R, Sgro JA, Towne AR, et al.: Prognostic value of EEG monitoring after status epilepticus: A prospective adult study. J Clin Neurophysiol 1997, 14:326–334.

    Article  PubMed  CAS  Google Scholar 

  21. Nei M, Lee JM, Shanker VL, Sperling MR: The EEG and prognosis in status epilepticus. Epilepsia 1999, 40:157–163.

    Article  PubMed  CAS  Google Scholar 

  22. Murthy JM, Narayanan J: Continuous EEG monitoring in the evaluation of non-convulsive seizures and status epilepticus. Neurol India 2004, 52:430–435.

    PubMed  CAS  Google Scholar 

  23. Hodges BM, Mazur JE: Intravenous valproate in status epilepticus. Ann Pharmacother 2001, 35:1465–1470.

    Article  PubMed  CAS  Google Scholar 

  24. Honack D, Loscher W: Intravenous valproate: onset and duration of anticonvulsant activity against a series of electroconvulsions in comparison with diazepam and phenytoin. Epilepsy Res 1992, 13:215–221.

    Article  PubMed  CAS  Google Scholar 

  25. Hovinga CA, Chicella MF, Rose DF, et al.: Use of intravenous valproate in three pediatric patients with nonconvulsive or convulsive status epilepticus. Ann Pharm 1999, 33:579–583.

    Article  CAS  Google Scholar 

  26. Yu KT, Mills S, Thompson N, Cunanan C: Safety and efficacy of intravenous valproate in pediatric status epilepticus and acute repetitive seizures. Epilepsia 2003, 44:724–726.

    Article  PubMed  CAS  Google Scholar 

  27. Uberal MA, Trollman R, Wunsiedler U, Wenzel D: Intravenous valproate in pediatric patients with refractory status epilepticus. Neurology 2000, 54:2188–2189.

    Google Scholar 

  28. Jha S, Jose M, Patel R: Intravenous sodium valproate in status epilepticus. Neurol India 2003, 51:421–422.

    PubMed  CAS  Google Scholar 

  29. Limdi NA, Shimpi AV, Faught E, et al.: Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology 2005, 64:353–355.

    PubMed  CAS  Google Scholar 

  30. Peters CN, Pohlmann-Eden B: Intravenous valproate as an innovative therapy in seizure emergency situations including status epilepticus—experience in 102 adult patients. Seizure 2005, 14:164–169.

    Article  PubMed  Google Scholar 

  31. Patel R, Jha S: Intravenous valproate in post-anoxic myoclonic status epilepticus: a report of ten patients. Neurol India 2004, 52:394–396.

    PubMed  CAS  Google Scholar 

  32. Limdi NA, Knowlton RK, Cofield SS, et al.: Safety of rapid intravenous loading of valproate. Epilepsia 2007, 48:478–483.

    Article  PubMed  CAS  Google Scholar 

  33. Sinha S, Naritoku DK: Intravenous valproate is well tolerated in unstable patients with status epilepticus. Neurology 2000, 55:722–724.

    PubMed  CAS  Google Scholar 

  34. Misra UK, Kalita J, Patel R: Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology 2006, 67:340–342.

    Article  PubMed  CAS  Google Scholar 

  35. Rossetti AO, Bromfield EB: Determinants of success in the use of oral levetiracetam in status epilepticus. Epilepsy Behav 2006, 8:651–654.

    Article  PubMed  Google Scholar 

  36. Patel NC, Landan IR, Levin J, et al.: The use of levetiracetam in refractory status epilepticus. Seizure 2006, 15:137–141.

    Article  PubMed  Google Scholar 

  37. Rupprecht S, Franke K, Fitzek S, et al.: Levetiracetam as a treatment option in non-convulsive status epilepticus. Epilepsy Res 2007, 73:238–244.

    Article  PubMed  CAS  Google Scholar 

  38. Schulze-Bonhage A, Hefft S, Oehl B: Termination of complex partial status epilepticus by intravenous levetiracetam — a case report. J Neurol Neurosurg Psychiatry 2007, In press.

  39. Ramael S, Daoust A, Otoul C, et al.: Levetiracetam intravenous infusion: a randomized, placebo-controlled safety and pharmacokinetic study. Epilepsia 2006, 47:1128–1135.

    Article  PubMed  CAS  Google Scholar 

  40. Towne AR, Garnett LK, Waterhouse EJ, et al.: The use of topiramate in refractory status epilepticus. Neurology 2003, 60:332–334.

    PubMed  CAS  Google Scholar 

  41. Kahriman M, Minecan D, Kutluay E, et al.: Efficacy of topiramate in children with refractory status epilepticus. Epilepsia 2003, 44:1353–1356.

    Article  PubMed  CAS  Google Scholar 

  42. Bensalem MK, Fakhoury TA: Topiramate and status epilepticus: report of three cases. Epilepsy Behav 2003, 4:757–760.

    Article  PubMed  Google Scholar 

  43. Perry MS, Holt PJ, Sladky JT: Topiramate loading for refractory status epilepticus in children. Epilepsia 2006, 47:1070–1071.

    Article  PubMed  Google Scholar 

  44. Alexopoulos A, Lachhwani DK, Gupta A, et al.: Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis. Neurology 2005, 64:567–570.

    PubMed  CAS  Google Scholar 

  45. Ma X, Liporace J, O’Connor MJ, Sperling MR: Neurosurgical treatment of medically intractable status epilepticus. Epilepsy Res 2001, 46:33–38.

    Article  PubMed  CAS  Google Scholar 

  46. Gorman DG, Shields D, Shewmon A, et al.: Neurosurgical treatment of refractory status epilepticus. Epilepsia 1992, 33:546–549.

    Article  PubMed  CAS  Google Scholar 

  47. Molyneaux PD, Barker RA, Thom M, et al.: Successful treatment of intractable epilepsia partialis continue with multiple subpial transections. J Neurol Neurosurg Psychiatry 1998, 65:137–138.

    Article  Google Scholar 

  48. Ng Y, Kim HL, Wheless JW: Successful neurosurgical treatment of childhood complex partial status epilepticus with focal resection. Epilepsia 2003, 44:468–471.

    Article  PubMed  Google Scholar 

  49. Duane DC, Ng Y, Rekate HL, et al.: Treatment of refractory status epilepticus with hemispherectomy. Epilepsia 2004, 45:1001–1004.

    Article  PubMed  Google Scholar 

  50. Costello DJ, Simon MV, Eskandar EN, et al.: Efficacy of surgical treatment of de novo, adult-onset, cryptogenic, refractory focal status epilepticus. Arch Neurol 2006, 63:895–901.

    Article  PubMed  Google Scholar 

  51. Mohammad IS, Otsubo H, Donner E, et al.: Magnetoencephalography for surgical treatment of refractory status epilepticus. Acta Neurol Scand 2007, 115:29–36.

    Article  Google Scholar 

  52. D’Giano CH, Garcia MD, Pomata H, Rabinowicz AL: Treatment of refractory partial status epilepticus with multiple subpial transaction: case report. Seizure 2001, 10:382–385.

    Article  PubMed  CAS  Google Scholar 

  53. Watson KR, Levisohn P, Miller BR, Freeman J: Vagal nerve stimulation for status epilepticus. Pediatr Neurosurg 2001, 34:190–192.

    Article  Google Scholar 

  54. Patwardhan RV, Dellabadia J Jr, Rashidi M, et al.: Control of refractory status epilepticus precipitated by anticonvulsant withdrawal using left vagal nerve stimulation: a case report. Surg Neurol 2005, 64:170–173.

    Article  PubMed  Google Scholar 

  55. Schrader LM, Stern JM, Wilson CL, et al.: Low frequency electrical stimulation through subdural electrodes in a case of refractory status epilepticus. Clin Neurophysiol 2006, 117:781–788.

    Article  PubMed  Google Scholar 

  56. Lisanby SH, Bazil CW, Resor SR, et al.: ECT in the treatment of status epilepticus. J ECT 2001, 17:210–215.

    Article  PubMed  CAS  Google Scholar 

  57. Griesemer DA, Kellner CH, Bealse MD, Smith GM: Electroconvulsive therapy for treatment of intractable seizures: initial findings in two children. Neurology 1997, 49:1389–1392.

    PubMed  CAS  Google Scholar 

  58. Carrasco Gonzalez MD, Palomar M, Rovira R: Electroconvulsive therapy for status epilepticus. Ann Intern Med 1997, 127:247–248.

    PubMed  CAS  Google Scholar 

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Correspondence to Frank W. Drislane.

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Selvitelli, M., Drislane, F.W. Recent developments in the diagnosis and treatment of status epilepticus. Curr Neurol Neurosci Rep 7, 529–535 (2007). https://doi.org/10.1007/s11910-007-0081-8

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