Skip to main content

Guidelines for the Evaluation and Management of Status Epilepticus

Abstract

Status epilepticus (SE) treatment strategies vary substantially from one institution to another due to the lack of data to support one treatment over another. To provide guidance for the acute treatment of SE in critically ill patients, the Neurocritical Care Society organized a writing committee to evaluate the literature and develop an evidence-based and expert consensus practice guideline. Literature searches were conducted using PubMed and studies meeting the criteria established by the writing committee were evaluated. Recommendations were developed based on the literature using standardized assessment methods from the American Heart Association and Grading of Recommendations Assessment, Development, and Evaluation systems, as well as expert opinion when sufficient data were lacking.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Beran RG. An alternative perspective on the management of status epilepticus. Epilepsy Behav. 2008;12(3):349–53.

    PubMed  Article  Google Scholar 

  2. 2.

    Seif-Eddeine H, Treiman DM. Problems and controversies in status epilepticus: a review and recommendations. Expert Rev Neurother. 2011;11(12):1747–58.

    PubMed  Article  Google Scholar 

  3. 3.

    Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011;10(10):922–30.

    PubMed  Article  Google Scholar 

  4. 4.

    Gibbons RJ, Smith S, Antman E. American College of Cardiology/American Heart Association clinical practice guidelines: Part I: where do they come from? Circulation. 2003;107(23):2979–86.

    PubMed  Article  Google Scholar 

  5. 5.

    Jaeschke R, Guyatt GH, Dellinger P, Schunemann H, Levy MM, Kunz R, Norris S, Bion J. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ. 2008;337:a744.

    PubMed  Article  Google Scholar 

  6. 6.

    Abend NS, Dlugos DJ, Hahn CD, Hirsch LJ, Herman ST. Use of EEG monitoring and management of non-convulsive seizures in critically ill patients: a survey of neurologists. Neurocrit Care. 2010;12(3):382–9.

    PubMed  Article  Google Scholar 

  7. 7.

    Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia. 2006;47(9):1499–503.

    PubMed  Article  Google Scholar 

  8. 8.

    Lowenstein DH. Current concepts: status epilepticus. N Engl J Med. 1998;338(14):970.

    PubMed  CAS  Article  Google Scholar 

  9. 9.

    Theodore WH, Porter RJ, Albert P, Kelley K, Bromfield E, Devinsky O, Sato S. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology. 1994;44(8):1403–7.

    PubMed  CAS  Article  Google Scholar 

  10. 10.

    Shinnar S. How long do new-onset seizures in children last? Ann Neurol. 2001;49(5):659–64.

    PubMed  CAS  Article  Google Scholar 

  11. 11.

    Meldrum BS, Horton RW. Physiology of status epilepticus in primates. Arch Neurol. 1973;28(1):1–9.

    PubMed  CAS  Article  Google Scholar 

  12. 12.

    Chen JWY, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5(3):246–56.

    PubMed  Article  Google Scholar 

  13. 13.

    Kapur J. Rapid seizure-induced reduction of benzodiazepine and Zn2 sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci. 1997;17(19):7532.

    PubMed  CAS  Google Scholar 

  14. 14.

    Mazarati AM. Time-dependent decrease in the effectiveness of antiepileptic drugs during the course of self-sustaining status epilepticus. Brain Res. 1998;814(1–2):179.

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Hirsch LJ. Status epilepticus. CONTINUUM Lifelong Learn Neurol. 2007;13(4):121–51.

    Google Scholar 

  16. 16.

    Lowenstein DH. Status epilepticus: an overview of the clinical problem. Epilepsia. 1999;40(Suppl 1):S3–8. discussion S21–22.

    PubMed  Article  Google Scholar 

  17. 17.

    Meldrum BS. The revised operational definition of generalised tonic-clonic (TC) status epilepticus in adults. Epilepsia. 1999;40(1):123–4.

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Knake S, Hamer HM, Rosenow F. Status epilepticus: a critical review. Epilepsy Behav. 2009;15(1):10–4.

    PubMed  Article  Google Scholar 

  19. 19.

    Alldredge BK. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345(9):631–7.

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Meierkord H, Boon P, Engelsen B, Göcke K, Shorvon S, Tinuper P, Holtkamp M. EFNS guideline on the management of status epilepticus. Eur J Neurol. 2006;13(5):445–50.

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Walker M. Status epilepticus: an evidence based guide. Br Med J (Clin Res Ed). 2005;331(7518):673–7.

    Article  Google Scholar 

  22. 22.

    Shorvon S. The management of status epilepticus. J Neurol Neurosurg Psychiatry. 2001;70(Suppl 2):22–7.

    Google Scholar 

  23. 23.

    Kaplan PW. Nonconvulsive status epilepticus in the emergency room. Epilepsia. 1996;37(7):643–50.

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Shorvon S. What is nonconvulsive status epilepticus, and what are its subtypes? Epilepsia. 2007;48(Suppl 8):35–8.

    PubMed  Article  Google Scholar 

  25. 25.

    Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR Jr, DeLorenzo RJ. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54(2):340–5.

    PubMed  CAS  Article  Google Scholar 

  26. 26.

    Rossetti AO, Reichhart MD, Schaller MD, Despland PA, Bogousslavsky J. Propofol treatment of refractory status epilepticus: a study of 31 episodes. Epilepsia. 2004;45(7):757–63.

    PubMed  CAS  Article  Google Scholar 

  27. 27.

    Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40(6):759–62.

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    Claassen J, Hirsch LJ, Emerson RG, Bates JE, Thompson TB, Mayer SA. Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology. 2001;57(6):1036–42.

    PubMed  CAS  Article  Google Scholar 

  29. 29.

    Arif H. Treatment of status epilepticus. Semin Neurol. 2008;28(03):342–54.

    PubMed  Article  Google Scholar 

  30. 30.

    Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, Handforth A, Faught E, Calabrese VP, Uthman BM, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans affairs status epilepticus cooperative study group. N Engl J Med. 1998;339(12):792–8.

    PubMed  CAS  Article  Google Scholar 

  31. 31.

    Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol. 2007;118(8):1660–70.

    PubMed  CAS  Article  Google Scholar 

  32. 32.

    Bleck TP. Refractory status epilepticus. Curr Opin Crit care. 2005;11(2):117–20.

    PubMed  Article  Google Scholar 

  33. 33.

    Shinnar S, Pellock JM, Moshe SL, Maytal J, O’Dell C, Driscoll SM, Alemany M, Newstein D, DeLorenzo RJ. In whom does status epilepticus occur: age-related differences in children. Epilepsia. 1997;38(8):907–14.

    PubMed  CAS  Article  Google Scholar 

  34. 34.

    Chin RF, Neville BG, Peckham C, Bedford H, Wade A, Scott RC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368(9531):222–9.

    PubMed  Article  Google Scholar 

  35. 35.

    Riviello JJ, Ashwal S, Hirtz D, Glauser T, Ballaban-Gil K, Kelley K, Morton LD, Phillips S, Sloan E, Shinnar S. Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review). Neurology. 2006;67(9):1542–50.

    PubMed  Article  Google Scholar 

  36. 36.

    Claassen J, Lokin JK, Fitzsimmons BF, Mendelsohn FA, Mayer SA. Predictors of functional disability and mortality after status epilepticus. Neurology. 2002;58(1):139–42.

    PubMed  CAS  Article  Google Scholar 

  37. 37.

    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(5):611–5.

    PubMed  CAS  Article  Google Scholar 

  38. 38.

    Novy J, Rossetti AO. Oral pregabalin as an add-on treatment for status epilepticus. Epilepsia. 2010;51(10):2207–10.

    PubMed  CAS  Article  Google Scholar 

  39. 39.

    Logroscino G, Hesdorffer DC, Cascino G, Annegers JF, Hauser WA. Short-term mortality after a first episode of status epilepticus. Epilepsia. 1997;38(12):1344–9.

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    Legriel S, Mourvillier B, Bele N, Amaro J, Fouet P, Manet P, Hilpert F. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med. 2008;34(3):476–80.

    PubMed  Article  Google Scholar 

  41. 41.

    Legriel S. Functional outcome after convulsive status epilepticus. Crit Care Med. 2010;38(12):2295–303.

    PubMed  Article  Google Scholar 

  42. 42.

    Logroscino G, Hesdorffer DC, Cascino GD, Annegers JF, Bagiella E, Hauser WA. Long-term mortality after a first episode of status epilepticus. Neurology. 2002;58(4):537–41.

    PubMed  CAS  Article  Google Scholar 

  43. 43.

    Riviello JJ, Holmes GL. The treatment of status epilepticus. Semin Pediatr Neurol. 2004;11(2):129–38.

    PubMed  Article  Google Scholar 

  44. 44.

    Oxbury JM. Causes and consequences of status epilepticus in adults. A study of 86 cases. Brain. 1971;94(4):733–44.

    PubMed  CAS  Article  Google Scholar 

  45. 45.

    Aminoff MJ, Simon RP. Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med. 1980;69(5):657–66.

    PubMed  CAS  Article  Google Scholar 

  46. 46.

    Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology. 1993;43(3 Pt 1):483–8.

    PubMed  CAS  Article  Google Scholar 

  47. 47.

    Scholtes FB, Renier WO, Meinardi H. Generalized convulsive status epilepticus: causes, therapy, and outcome in 346 patients. Epilepsia. 1994;35(5):1104–12.

    PubMed  CAS  Article  Google Scholar 

  48. 48.

    Logroscino G, Hesdorffer DC, Cascino G, Annegers JF, Hauser WA. Time trends in incidence, mortality, and case-fatality after first episode of status epilepticus. Epilepsia. 2001;42(8):1031–5.

    PubMed  CAS  Article  Google Scholar 

  49. 49.

    Delanty N, French JA, Labar DR, Pedley TA, Rowan AJ. Status epilepticus arising de novo in hospitalized patients: an analysis of 41 patients. Seizure. 2001;10(2):116–9.

    PubMed  CAS  Google Scholar 

  50. 50.

    Aranda A, Foucart G, Ducassé JL, Grolleau S, McGonigal A, Valton L. Generalized convulsive status epilepticus management in adults: a cohort study with evaluation of professional practice. Epilepsia. 2010;51(10):2159–67.

    PubMed  Article  Google Scholar 

  51. 51.

    Young B, Jordan K, Doig G. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.

    PubMed  CAS  Article  Google Scholar 

  52. 52.

    Litt B, Wityk RJ, Hertz SH, Mullen PD, Weiss H, Ryan DD, Henry TR. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia. 1998;39(11):1194–202.

    PubMed  CAS  Article  Google Scholar 

  53. 53.

    Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology. 2003;61(8):1066–73.

    PubMed  Article  Google Scholar 

  54. 54.

    DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, DeLorenzo GA, Brown A, Garnett L. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.

    PubMed  CAS  Article  Google Scholar 

  55. 55.

    Young GB, Blume WT, Bolton CF, Warren KG. Anesthetic barbiturates in refractory status epilepticus. Can J Neurol Sci. 1980;7(4):291–2.

    PubMed  CAS  Google Scholar 

  56. 56.

    Rashkin MC, Youngs C, Penovich P. Pentobarbital treatment of refractory status epilepticus. Neurology. 1987;37(3):500.

    PubMed  CAS  Article  Google Scholar 

  57. 57.

    Osorio I, Reed RC. Treatment of refractory generalized tonic-clonic status epilepticus with pentobarbital anesthesia after high-dose phenytoin. Epilepsia. 1989;30(4):464–71.

    PubMed  CAS  Article  Google Scholar 

  58. 58.

    Van Ness PC. Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin. Epilepsia. 1990;31(1):61–7.

    PubMed  Article  Google Scholar 

  59. 59.

    Yaffe K, Lowenstein DH. Prognostic factors of pentobarbital therapy for refractory generalized status epilepticus. Neurology. 1993;43(5):895.

    PubMed  CAS  Article  Google Scholar 

  60. 60.

    Sagduyu A, Tarlaci S, Sirin H. Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality. J Neurol. 1998;245(10):640–6.

    PubMed  CAS  Article  Google Scholar 

  61. 61.

    Brown L. Role of propofol in refractory status epilepticus. Ann Pharmacother. 1998;32(10):1053–9.

    PubMed  CAS  Article  Google Scholar 

  62. 62.

    Stecker MM, Kramer TH, Raps EC, O’Meeghan R, Dulaney E, Skaar DJ. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia. 1998;39(1):18–26.

    PubMed  CAS  Article  Google Scholar 

  63. 63.

    Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43(2):146–53.

    PubMed  CAS  Article  Google Scholar 

  64. 64.

    Drislane FW, Blum AS, Lopez MR, Gautam S, Schomer DL. Duration of refractory status epilepticus and outcome: loss of prognostic utility after several hours. Epilepsia. 2009;50(6):1566–71.

    PubMed  Article  Google Scholar 

  65. 65.

    Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005;76(4):534–9.

    PubMed  CAS  Article  Google Scholar 

  66. 66.

    Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol. 2005;62(11):1698–702.

    PubMed  Article  Google Scholar 

  67. 67.

    Drislane FW, Lopez MR, Blum AS, Schomer DL. Detection and treatment of refractory status epilepticus in the intensive care unit. J Clin Neurophysiol. 2008;25(4):181–6.

    PubMed  Article  Google Scholar 

  68. 68.

    Rossetti AO, Milligan TA, Vulliemoz S, Michaelides C, Bertschi M, Lee JW. A randomized trial for the treatment of refractory status epilepticus. Neurocrit Care. 2011;14(1):4–10.

    PubMed  CAS  Article  Google Scholar 

  69. 69.

    Saz EU, Karapinar B, Ozcetin M, Polat M, Tosun A, Serdaroglu G, Gokben S, Tekgul H. Convulsive status epilepticus in children: etiology, treatment protocol and outcome. Seizure. 2011;20(2):115–8.

    PubMed  Article  Google Scholar 

  70. 70.

    Sahin M, Menache CC, Holmes GL, Riviello JJ. Outcome of severe refractory status epilepticus in children. Epilepsia. 2001;42(11):1461–7.

    PubMed  CAS  Article  Google Scholar 

  71. 71.

    Sahin M, Menache CC, Holmes GL, Riviello JJ. Prolonged treatment for acute symptomatic refractory status epilepticus. Neurology. 2003;61(3):398–401.

    PubMed  Article  Google Scholar 

  72. 72.

    Gilbert DL, Gartside PS, Glauser TA. Efficacy and mortality in treatment of refractory generalized convulsive status epilepticus in children: a meta-analysis. J Child Neurol. 1999;14(9):602–9.

    PubMed  CAS  Article  Google Scholar 

  73. 73.

    Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons B-F. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol. 2002;59(2):205–10.

    PubMed  Article  Google Scholar 

  74. 74.

    Maytal J, Shinnar S, Moshé SL, Alvarez LA. Low morbidity and mortality of status epilepticus in children. Pediatrics. 1989;83(3):323–31.

    PubMed  CAS  Google Scholar 

  75. 75.

    Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia. 1994;35(1):27–34.

    PubMed  CAS  Article  Google Scholar 

  76. 76.

    Lewena S, Pennington V, Acworth J, Thornton S, Ngo P, McIntyre S, Krieser D, Neutze J, Speldewinde D. Emergency management of pediatric convulsive status epilepticus: a multicenter study of 542 patients. Pediatr Emerg Care. 2009;25(2):83–7.

    PubMed  Article  Google Scholar 

  77. 77.

    Roppolo LP, Walters K. Airway management in neurological emergencies. Neurocrit Care. 2004;1(4):405–14.

    PubMed  Article  Google Scholar 

  78. 78.

    van Rijckevorsel K, Boon P, Hauman H, Legros B, Ossemanns M, Sadzot B, Schmedding E, van Zandijcke M. Standards of care for adults with convulsive status epilepticus: Belgian consensus recommendations. Acta Neurol Belg. 2005;105(3):111–8.

    PubMed  Google Scholar 

  79. 79.

    Varelas PN, Mirski MA. Status epilepticus. Curr Neurol Neurosci Rep. 2009;9(6):469–76.

    PubMed  Article  Google Scholar 

  80. 80.

    Privitera M, Hoffman M, Moore JL, Jester D. EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res. 1994;18(2):155–66.

    PubMed  CAS  Article  Google Scholar 

  81. 81.

    Drislane FW. Presentation, evaluation, and treatment of nonconvulsive status epilepticus. Epilepsy Behav. 2000;1(5):301–14.

    PubMed  CAS  Article  Google Scholar 

  82. 82.

    Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med. 2009;37(6):2051–6.

    PubMed  Article  Google Scholar 

  83. 83.

    Leppik IE, Derivan AT, Homan RW, Walker J, Ramsay RE, Patrick B. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA. 1983;249(11):1452–4.

    PubMed  CAS  Article  Google Scholar 

  84. 84.

    Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, Barsan W. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366(7):591–600.

    PubMed  CAS  Article  Google Scholar 

  85. 85.

    Alvarez N, Besag F, Iivanainen M. Use of antiepileptic drugs in the treatment of epilepsy in people with intellectual disability. J Intellect Disabil Res. 1998;42(Suppl 1):1–15.

    PubMed  Google Scholar 

  86. 86.

    Troester MM, Hastriter EV, Ng YT. Dissolving oral clonazepam wafers in the acute treatment of prolonged seizures. J Child Neurol. 2010;25(12):1468–72.

    PubMed  Article  Google Scholar 

  87. 87.

    Treiman DM, Walker MC. Treatment of seizure emergencies: convulsive and non-convulsive status epilepticus. Epilepsy Res. 2006;68(Suppl 1):S77–82.

    PubMed  CAS  Article  Google Scholar 

  88. 88.

    Appleton R, Sweeney A, Choonara I, Robson J, Molyneux E. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Dev Med Child Neurol. 1995;37(8):682–8.

    PubMed  CAS  Article  Google Scholar 

  89. 89.

    Walker JE, Homan RW, Vasko MR, Crawford IL, Bell RD, Tasker WG. Lorazepam in status epilepticus. Ann Neurol. 1979;6(3):207–13.

    PubMed  CAS  Article  Google Scholar 

  90. 90.

    Cock HR, Schapira AH. A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM. 2002;95(4):225–31.

    PubMed  CAS  Article  Google Scholar 

  91. 91.

    Crawford TO, Mitchell WG, Snodgrass SR. Lorazepam in childhood status epilepticus and serial seizures: effectiveness and tachyphylaxis. Neurology. 1987;37(2):190–5.

    PubMed  CAS  Article  Google Scholar 

  92. 92.

    Kapur J. Prehospital treatment of status epilepticus with benzodiazepines is effective and safe. Epilepsy Curr. 2002;2(4):121–4.

    PubMed  Article  Google Scholar 

  93. 93.

    Treiman DM. Treatment of convulsive status epilepticus. Int Rev Neurobiol. 2007;81:273–85.

    PubMed  Article  Google Scholar 

  94. 94.

    Prasad K, Krishnan PR, Al-Roomi K, Sequeira R. Anticonvulsant therapy for status epilepticus. Br J Clin Pharmacol. 2007;63(6):640–7.

    PubMed  CAS  Article  Google Scholar 

  95. 95.

    Giang DW, McBride MC. Lorazepam versus diazepam for the treatment of status epilepticus. Pediatr Neurol. 1988;4(6):358–61.

    PubMed  CAS  Article  Google Scholar 

  96. 96.

    Labar DR, Ali A, Root J. High-dose intravenous lorazepam for the treatment of refractory status epilepticus. Neurology. 1994;44(8):1400–3.

    PubMed  CAS  Article  Google Scholar 

  97. 97.

    Sreenath TG, Gupta P, Sharma KK, Krishnamurthy S. Lorazepam versus diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children: a randomized controlled trial. Eur J Paediatr Neurol. 2010;14(2):162–8.

    PubMed  CAS  Article  Google Scholar 

  98. 98.

    Qureshi A, Wassmer E, Davies P, Berry K, Whitehouse WP. Comparative audit of intravenous lorazepam and diazepam in the emergency treatment of convulsive status epilepticus in children. Seizure. 2002;11(3):141–4.

    PubMed  CAS  Article  Google Scholar 

  99. 99.

    McMullan J, Sasson C, Pancioli A, Silbergleit R. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med. 2010;17(6):575–82.

    PubMed  Article  Google Scholar 

  100. 100.

    Nakken KO, Lossius MI. Buccal midazolam or rectal diazepam for treatment of residential adult patients with serial seizures or status epilepticus. Acta Neurol Scand. 2011;124(2):99–103.

    PubMed  CAS  Article  Google Scholar 

  101. 101.

    Baysun S, Aydin OF, Atmaca E, Gurer YK. A comparison of buccal midazolam and rectal diazepam for the acute treatment of seizures. Clin Pediatr (Phila). 2005;44(9):771–6.

    Article  Google Scholar 

  102. 102.

    Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ. 2000;321(7253):83–6.

    PubMed  CAS  Article  Google Scholar 

  103. 103.

    McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, Martland T, Berry K, Collier J, Smith S, 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.

    PubMed  CAS  Article  Google Scholar 

  104. 104.

    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.

    PubMed  CAS  Article  Google Scholar 

  105. 105.

    Mahmoudian T, Zadeh MM. Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav. 2004;5(2):253–5.

    PubMed  CAS  Article  Google Scholar 

  106. 106.

    Yoshikawa H, Yamazaki S, Abe T, Oda Y. Midazolam as a first-line agent for status epilepticus in children. Brain Dev. 2000;22(4):239–42.

    PubMed  CAS  Article  Google Scholar 

  107. 107.

    Brevoord JC, Joosten KF, Arts WF, van Rooij RW, de Hoog M. Status epilepticus: clinical analysis of a treatment protocol based on midazolam and phenytoin. J Child Neurol. 2005;20(6):476–81.

    PubMed  Google Scholar 

  108. 108.

    Koul RL, Raj Aithala G, Chacko A, Joshi R, Elbualy M. Continuous midazolam infusion as treatment of status epilepticus. Arch Dis Child. 1997;76(5):445–8.

    PubMed  CAS  Article  Google Scholar 

  109. 109.

    Nicol CF, Tutton JC, Smith BH. Parenteral diazepam in status epilepticus. Neurology. 1969;19(4):332–43.

    PubMed  CAS  Article  Google Scholar 

  110. 110.

    Parsonage MJ, Norris JW. Use of diazepam in treatment of severe convulsive status epilepticus. Br Med J. 1967;3(5557):85–8.

    PubMed  CAS  Article  Google Scholar 

  111. 111.

    Dieckmann RA. Rectal diazepam for prehospital pediatric status epilepticus. Ann Emerg Med. 1994;23(2):216–24.

    PubMed  CAS  Article  Google Scholar 

  112. 112.

    McMorris S, McWilliam PK. Status epilepticus in infants and young children treated with parenteral diazepam. Arch Dis Child. 1969;44(237):604–11.

    PubMed  CAS  Article  Google Scholar 

  113. 113.

    Lombroso CT. Treatment of status epilepticus with diazepam. Neurology. 1966;16(7):629–34.

    PubMed  CAS  Article  Google Scholar 

  114. 114.

    Shaner DM, McCurdy SA, Herring MO, Gabor AJ. Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology. 1988;38(2):202–7.

    PubMed  CAS  Article  Google Scholar 

  115. 115.

    Sugai K. Treatment of convulsive status epilepticus in infants and young children in Japan. Acta Neurol Scand Suppl. 2007;186:62–70.

    PubMed  CAS  Article  Google Scholar 

  116. 116.

    Gilad R, Izkovitz N, Dabby R, Rapoport A, Sadeh M, Weller B, Lampl Y. Treatment of status epilepticus and acute repetitive seizures with i.v. valproic acid vs phenytoin. Acta Neurol Scand. 2008;118(5):296–300.

    PubMed  CAS  Article  Google Scholar 

  117. 117.

    Misra UK, Kalita J, Patel R. Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology. 2006;67(2):340–2.

    PubMed  CAS  Article  Google Scholar 

  118. 118.

    Prasad K, Al-Roomi K, Krishnan PR, Sequeira R: Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev 2005(4):CD003723.

  119. 119.

    Swisher CB, Doreswamy M, Gingrich KJ, Vredenburgh JJ, Kolls BJ. Phenytoin, levetiracetam, and pregabalin in the acute management of refractory status epilepticus in patients with brain tumors. Neurocrit Care. 2011;16(1):109–13.

    Article  CAS  Google Scholar 

  120. 120.

    Limdi NA, Shimpi AV, Faught E, Gomez CR, Burneo JG. Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology. 2005;64(2):353–5.

    PubMed  CAS  Article  Google Scholar 

  121. 121.

    Giroud M. Use of injectable valproic acid in status epilepticus: a pilot study. Clinical Drug Investig. 1993;5:154.

    Google Scholar 

  122. 122.

    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(3):164–9.

    PubMed  Article  Google Scholar 

  123. 123.

    Berning S, Boesebeck F, van Baalen A, Kellinghaus C. Intravenous levetiracetam as treatment for status epilepticus. J Neurol. 2009;256(10):1634–42.

    PubMed  CAS  Article  Google Scholar 

  124. 124.

    Eue S, Grumbt M, Muller M, Schulze A. Two years of experience in the treatment of status epilepticus with intravenous levetiracetam. Epilepsy Behav. 2009;15(4):467–9.

    PubMed  CAS  Article  Google Scholar 

  125. 125.

    Beyenburg S, Reuber M, Maraite N. Intravenous levetiracetam for epileptic seizure emergencies in older people. Gerontology. 2009;55(1):27–31.

    PubMed  Article  Google Scholar 

  126. 126.

    Ruegg S, Naegelin Y, Hardmeier M, Winkler DT, Marsch S, Fuhr P. Intravenous levetiracetam: treatment experience with the first 50 critically ill patients. Epilepsy Behav. 2008;12(3):477–80.

    PubMed  Article  Google Scholar 

  127. 127.

    Rupprecht S, Franke K, Fitzek S, Witte OW, Hagemann G. Levetiracetam as a treatment option in non-convulsive status epilepticus. Epilepsy Res. 2007;73(3):238–44.

    PubMed  CAS  Article  Google Scholar 

  128. 128.

    Fattouch J, Di Bonaventura C, Casciato S, Bonini F, Petrucci S, Lapenta L, Manfredi M, Prencipe M, Giallonardo AT. Intravenous levetiracetam as first-line treatment of status epilepticus in the elderly. Acta Neurol Scand. 2010;121(6):418–21.

    PubMed  CAS  Article  Google Scholar 

  129. 129.

    Abend NS, Monk HM, Licht DJ, Dlugos DJ. Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med. 2009;10(4):505–10.

    PubMed  Article  Google Scholar 

  130. 130.

    Uges JW, van Huizen MD, Engelsman J, Wilms EB, Touw DJ, Peeters E, Vecht CJ. Safety and pharmacokinetics of intravenous levetiracetam infusion as add-on in status epilepticus. Epilepsia. 2009;50(3):415–21.

    PubMed  CAS  Article  Google Scholar 

  131. 131.

    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(5):724–6.

    PubMed  CAS  Article  Google Scholar 

  132. 132.

    Agarwal P, Kumar N, Chandra R, Gupta G, Antony AR, Garg N. Randomized study of intravenous valproate and phenytoin in status epilepticus. Seizure. 2007;16(6):527–32.

    PubMed  Article  Google Scholar 

  133. 133.

    Alvarez V, Januel JM, Burnand B, Rossetti AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011;52(7):1292–6.

    PubMed  CAS  Article  Google Scholar 

  134. 134.

    Chen L, Feng P, Wang J, Liu L, Zhou D. Intravenous sodium valproate in mainland China for the treatment of diazepam refractory convulsive status epilepticus. J Clin Neurosci. 2009;16(4):524–6.

    PubMed  CAS  Article  Google Scholar 

  135. 135.

    Olsen KB, Tauboll E, Gjerstad L. Valproate is an effective, well-tolerated drug for treatment of status epilepticus/serial attacks in adults. Acta Neurol Scand Suppl. 2007;187:51–4.

    PubMed  CAS  Article  Google Scholar 

  136. 136.

    Sinha S, Naritoku DK. Intravenous valproate is well tolerated in unstable patients with status epilepticus. Neurology. 2000;55(5):722–4.

    PubMed  CAS  Article  Google Scholar 

  137. 137.

    Chin RF, Neville BG, Peckham C, Wade A, Bedford H, Scott RC. Treatment of community-onset, childhood convulsive status epilepticus: a prospective, population-based study. Lancet Neurol. 2008;7(8):696–703.

    PubMed  CAS  Article  Google Scholar 

  138. 138.

    Crawford TO, Mitchell WG, Fishman LS, Snodgrass SR. Very-high-dose phenobarbital for refractory status epilepticus in children. Neurology. 1988;38(7):1035–40.

    PubMed  CAS  Article  Google Scholar 

  139. 139.

    Lowenstein DH, Aminoff MJ, Simon RP. Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. Neurology. 1988;38(3):395–400.

    PubMed  CAS  Article  Google Scholar 

  140. 140.

    Moddel G, Bunten S, Dobis C, Kovac S, Dogan M, Fischera M, Dziewas R, Schabitz WR, Evers S, Happe S. Intravenous levetiracetam: a new treatment alternative for refractory status epilepticus. J Neurol Neurosurg Psychiatry. 2009;80(6):689–92.

    PubMed  CAS  Article  Google Scholar 

  141. 141.

    Gamez-Leyva G, Aristin JL, Fernandez E, Pascual J. Experience with intravenous levetiracetam in status epilepticus: a retrospective case series. CNS Drugs. 2009;23(11):983–7.

    PubMed  CAS  Article  Google Scholar 

  142. 142.

    Singhi S, Murthy A, Singhi P, Jayashree M. Continuous midazolam versus diazepam infusion for refractory convulsive status epilepticus. J Child Neurol. 2002;17(2):106–10.

    PubMed  Article  Google Scholar 

  143. 143.

    Ozdemir D, Gulez P, Uran N, Yendur G, Kavakli T, Aydin A. Efficacy of continuous midazolam infusion and mortality in childhood refractory generalized convulsive status epilepticus. Seizure. 2005;14(2):129–32.

    PubMed  Article  Google Scholar 

  144. 144.

    Prasad A, Worrall BB, Bertram EH, Bleck TP. Propofol and midazolam in the treatment of refractory status epilepticus. Epilepsia. 2001;42(3):380–6.

    PubMed  CAS  Article  Google Scholar 

  145. 145.

    Ulvi H, Yoldas T, Mungen B, Yigiter R. Continuous infusion of midazolam in the treatment of refractory generalized convulsive status epilepticus. Neurol Sci. 2002;23(4):177–82.

    PubMed  CAS  Article  Google Scholar 

  146. 146.

    Rivera R, Segnini M, Baltodano A, Perez V. Midazolam in the treatment of status epilepticus in children. Crit Care Med. 1993;21(7):991–4.

    PubMed  CAS  Article  Google Scholar 

  147. 147.

    Kumar A, Bleck TP. Intravenous midazolam for the treatment of refractory status epilepticus. Crit Care Med. 1992;20(4):483–8.

    PubMed  CAS  Article  Google Scholar 

  148. 148.

    Koul R, Chacko A, Javed H, Al Riyami K. Eight-year study of childhood status epilepticus: midazolam infusion in management and outcome. J Child Neurol. 2002;17(12):908–10.

    PubMed  Article  Google Scholar 

  149. 149.

    Igartua J, Silver P, Maytal J, Sagy M. Midazolam coma for refractory status epilepticus in children. Crit Care Med. 1999;27(9):1982–5.

    PubMed  CAS  Article  Google Scholar 

  150. 150.

    Morrison G, Gibbons E, Whitehouse WP. High-dose midazolam therapy for refractory status epilepticus in children. Intensive Care Med. 2006;32(12):2070–6.

    PubMed  CAS  Article  Google Scholar 

  151. 151.

    Cornfield DN, Tegtmeyer K, Nelson MD, Milla CE, Sweeney M. Continuous propofol infusion in 142 critically ill children. Pediatrics. 2002;110(6):1177–81.

    PubMed  Article  Google Scholar 

  152. 152.

    Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36(8):2281–7.

    PubMed  CAS  Article  Google Scholar 

  153. 153.

    Parviainen I, Uusaro A, Kalviainen R, Mervaala E, Ruokonen E. Propofol in the treatment of refractory status epilepticus. Intensive Care Med. 2006;32(7):1075–9.

    PubMed  CAS  Article  Google Scholar 

  154. 154.

    van Gestel JP, Blusse van Oud-Alblas HJ, Malingre M, Ververs FF, Braun KP, van Nieuwenhuizen O. Propofol and thiopental for refractory status epilepticus in children. Neurology. 2005;65(4):591–2.

    PubMed  Article  CAS  Google Scholar 

  155. 155.

    Iyer VN, Hoel R, Rabinstein AA. Propofol infusion syndrome in patients with refractory status epilepticus: an 11-year clinical experience. Crit Care Med. 2009;37(12):3024–30.

    PubMed  CAS  Article  Google Scholar 

  156. 156.

    Krishnamurthy KB, Drislane FW. Relapse and survival after barbiturate anesthetic treatment of refractory status epilepticus. Epilepsia. 1996;37(9):863–7.

    PubMed  CAS  Article  Google Scholar 

  157. 157.

    ter Maaten JC, Strack van Schijndel RJ, Heimans JJ, Schreuder WO. Ten patients with refractory status epilepticus in an intensive care department. Neth J Med. 1998;53(6):260–5.

    PubMed  Article  Google Scholar 

  158. 158.

    Partinen M, Kovanen J, Nilsson E. Status epilepticus treated by barbiturate anaesthesia with continuous monitoring of cerebral function. Br Med J (Clin Res Ed). 1981;282(6263):520–1.

    CAS  Article  Google Scholar 

  159. 159.

    Tripathi M, Vibha D, Choudhary N, Prasad K, Srivastava MV, Bhatia R, Chandra SP. Management of refractory status epilepticus at a tertiary care centre in a developing country. Seizure. 2010;19(2):109–11.

    PubMed  Article  Google Scholar 

  160. 160.

    Mehta V, Singhi P, Singhi S. Intravenous sodium valproate versus diazepam infusion for the control of refractory status epilepticus in children: a randomized controlled trial. J Child Neurol. 2007;22(10):1191–7.

    PubMed  Article  Google Scholar 

  161. 161.

    Uberall MA, Trollmann R, Wunsiedler U, Wenzel D. Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology. 2000;54(11):2188–9.

    PubMed  CAS  Article  Google Scholar 

  162. 162.

    Knake S, Gruener J, Hattemer K, Klein KM, Bauer S, Oertel WH, Hamer HM, Rosenow F. Intravenous levetiracetam in the treatment of benzodiazepine refractory status epilepticus. J Neurol Neurosurg Psychiatry. 2008;79(5):588–9.

    PubMed  CAS  Article  Google Scholar 

  163. 163.

    Patel NC, Landan IR, Levin J, Szaflarski J, Wilner AN. The use of levetiracetam in refractory status epilepticus. Seizure. 2006;15(3):137–41.

    PubMed  Article  Google Scholar 

  164. 164.

    Gallentine WB, Hunnicutt AS, Husain AM. Levetiracetam in children with refractory status epilepticus. Epilepsy Behav. 2009;14(1):215–8.

    PubMed  Article  Google Scholar 

  165. 165.

    Miyahara A, Saito Y, Sugai K, Nakagawa E, Sakuma H, Komaki H, Sasaki M. Reassessment of phenytoin for treatment of late stage progressive myoclonus epilepsy complicated with status epilepticus. Epilepsy Res. 2009;84(2–3):201–9.

    PubMed  CAS  Article  Google Scholar 

  166. 166.

    Albers JM, Moddel G, Dittrich R, Steidl C, Suntrup S, Ringelstein EB, Dziewas R. Intravenous lacosamide: an effective add-on treatment of refractory status epilepticus. Seizure. 2011;20(5):428–30.

    PubMed  Article  Google Scholar 

  167. 167.

    Goodwin H, Hinson HE, Shermock KM, Karanjia N, Lewin JJ 3rd. The use of lacosamide in refractory status epilepticus. Neurocrit Care. 2011;14(3):348–53.

    PubMed  CAS  Article  Google Scholar 

  168. 168.

    Kellinghaus C, Berning S, Immisch I, Larch J, Rosenow F, Rossetti AO, Tilz C, Trinka E. Intravenous lacosamide for treatment of status epilepticus. Acta Neurol Scand. 2011;123(2):137–41.

    PubMed  CAS  Article  Google Scholar 

  169. 169.

    Towne AR, Garnett LK, Waterhouse EJ, Morton LD, DeLorenzo RJ. The use of topiramate in refractory status epilepticus. Neurology. 2003;60(2):332–4.

    PubMed  CAS  Article  Google Scholar 

  170. 170.

    Shearer P, Riviello J. Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols. Emerg Med Clin North Am. 2011;29(1):51–64.

    PubMed  Article  Google Scholar 

  171. 171.

    Rossetti AO. Which anesthetic should be used in the treatment of refractory status epilepticus? Epilepsia. 2007;48(Suppl 8):52–5.

    PubMed  Article  Google Scholar 

  172. 172.

    Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011;134(Pt 10):2802–18.

    PubMed  Article  Google Scholar 

  173. 173.

    Cooper AD, Britton JW, Rabinstein AA. Functional and cognitive outcome in prolonged refractory status epilepticus. Arch Neurol. 2009;66(12):1505–9.

    PubMed  Article  Google Scholar 

  174. 174.

    Lee WK, Liu KT, Young BW. Very-high-dose phenobarbital for childhood refractory status epilepticus. Pediatr Neurol. 2006;34(1):63–5.

    PubMed  Article  Google Scholar 

  175. 175.

    Mirski MA, Williams MA, Hanley DF. Prolonged pentobarbital and phenobarbital coma for refractory generalized status epilepticus. Crit Care Med. 1995;23(2):400–4.

    PubMed  CAS  Article  Google Scholar 

  176. 176.

    Bramstedt KA, Morris HH, Tanner A. Now we lay them down to sleep: ethical issues with the use of pharmacologic coma for adult status epilepticus. Epilepsy Behav. 2004;5(5):752–5.

    PubMed  Article  Google Scholar 

  177. 177.

    Dara SI, Tungpalan LA, Manno EM, Lee VH, Moder KG, Keegan MT, Fulgham JR, Brown DR, Berge KH, Whalen FX, et al. Prolonged coma from refractory status epilepticus. Neurocrit Care. 2006;4(2):140–2.

    PubMed  Article  Google Scholar 

  178. 178.

    Kramer U, Shorer Z, Ben-Zeev B, Lerman-Sagie T, Goldberg-Stern H, Lahat E. Severe refractory status epilepticus owing to presumed encephalitis. J Child Neurol. 2005;20(3):184–7.

    PubMed  Google Scholar 

  179. 179.

    Mewasingh LD, Sekhara T, Aeby A, Christiaens FJ, Dan B. Oral ketamine in paediatric non-convulsive status epilepticus. Seizure. 2003;12(7):483–9.

    PubMed  CAS  Article  Google Scholar 

  180. 180.

    Haberlandt E, Weger C, Sigl SB, Rauchenzauner M, Scholl-Burgi S, Rostasy K, Karall D. Adrenocorticotropic hormone versus pulsatile dexamethasone in the treatment of infantile epilepsy syndromes. Pediatr Neurol. 2010;42(1):21–7.

    PubMed  Article  Google Scholar 

  181. 181.

    Granata T, Fusco L, Gobbi G, Freri E, Ragona F, Broggi G, Mantegazza R, Giordano L, Villani F, Capovilla G, et al. Experience with immunomodulatory treatments in Rasmussen’s encephalitis. Neurology. 2003;61(12):1807–10.

    PubMed  CAS  Article  Google Scholar 

  182. 182.

    Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004;61(8):1254–9.

    PubMed  Article  Google Scholar 

  183. 183.

    Kofke WA, Young RS, Davis P, Woelfel SK, Gray L, Johnson D, Gelb A, Meeke R, Warner DS, Pearson KS, et al. Isoflurane for refractory status epilepticus: a clinical series. Anesthesiology. 1989;71(5):653–9.

    PubMed  CAS  Article  Google Scholar 

  184. 184.

    Zamponi N, Rychlicki F, Corpaci L, Cesaroni E, Trignani R. Vagus nerve stimulation (VNS) is effective in treating catastrophic 1 epilepsy in very young children. Neurosurg Rev. 2008;31(3):291–7.

    PubMed  Article  Google Scholar 

  185. 185.

    Shahwan A, Bailey C, Maxiner W, Harvey AS. Vagus nerve stimulation for refractory epilepsy in children: more to VNS than seizure frequency reduction. Epilepsia. 2009;50(5):1220–8.

    PubMed  Article  Google Scholar 

  186. 186.

    Abend NS, Dlugos DJ. Treatment of refractory status epilepticus: literature review and a proposed protocol. Pediatr Neurol. 2008;38(6):377–90.

    PubMed  Article  Google Scholar 

  187. 187.

    Nabbout R. Efficacy of ketogenic diet in severe refractory status epilepticus initiating fever induced refractory epileptic encephalopathy in school age children (FIRES). Epilepsia (Copenhagen). 2010;51(10):2033.

    Article  Google Scholar 

  188. 188.

    Nam SH, Lee BL, Lee CG, Yu HJ, Joo EY, Lee J, Lee M. The role of ketogenic diet in the treatment of refractory status epilepticus. Epilepsia. 2011;52(11):e181–4.

    PubMed  CAS  Article  Google Scholar 

  189. 189.

    Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008;9(2):189–97.

    PubMed  CAS  Article  Google Scholar 

  190. 190.

    Orlowski JP, Erenberg G, Lueders H, Cruse RP. Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med. 1984;12(4):367–72.

    PubMed  CAS  Article  Google Scholar 

  191. 191.

    Kamel H, Cornes SB, Hegde M, Hall SE, Josephson SA. Electroconvulsive therapy for refractory status epilepticus: a case series. Neurocrit Care. 2010;12(2):204–10.

    PubMed  Article  Google Scholar 

  192. 192.

    Rotenberg A, Muller P, Birnbaum D, Harrington M, Riviello JJ, Pascual-Leone A, Jensen FE. Seizure suppression by EEG-guided repetitive transcranial magnetic stimulation in the rat. Clin Neurophysiol. 2008;119(12):2697–702.

    PubMed  Article  Google Scholar 

  193. 193.

    Loddenkemper T, Cosmo G, Kotagal P, Haut J, Klaas P, Gupta A, Lachhwani DK, Bingaman W, Wyllie E. Epilepsy surgery in children with electrical status epilepticus in sleep. Neurosurgery. 2009;64(2):328–37. discussion 337.

    PubMed  Article  Google Scholar 

  194. 194.

    Alexopoulos A, Lachhwani DK, Gupta A, Kotagal P, Harrison AM, Bingaman W, Wyllie E. Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis. Neurology. 2005;64(3):567–70.

    PubMed  CAS  Article  Google Scholar 

  195. 195.

    Ng YT, Kerrigan JF, Rekate HL. Neurosurgical treatment of status epilepticus. J Neurosurg. 2006;105(Suppl 5):378–81.

    PubMed  Google Scholar 

  196. 196.

    Ma X, Liporace J, O’Connor MJ, Sperling MR. Neurosurgical treatment of medically intractable status epilepticus. Epilepsy Res. 2001;46(1):33–8.

    PubMed  CAS  Article  Google Scholar 

  197. 197.

    Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology. 2009;72(8):744–9.

    PubMed  Article  Google Scholar 

  198. 198.

    Rundgren M, Westhall E, Cronberg T, Rosen I, Friberg H. Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients. Crit Care Med. 2010;38(9):1838–44.

    PubMed  Article  Google Scholar 

  199. 199.

    Rossetti AO. What is the value of hypothermia in acute neurologic diseases and status epilepticus? Epilepsia. 2011;52(Suppl 8):64–6.

    PubMed  Article  Google Scholar 

  200. 200.

    de Pont AC, de Jager CP, van den Bergh WM, Schultz MJ. Recovery from near drowning and postanoxic status epilepticus with controlled hypothermia. Neth J Med. 2011;69(4):196–7.

    PubMed  Google Scholar 

  201. 201.

    Shorvon S. Super-refractory status epilepticus: an approach to therapy in this difficult clinical situation. Epilepsia. 2011;52(Suppl 8):53–6.

    PubMed  CAS  Article  Google Scholar 

  202. 202.

    Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, Wiebe S, Gronseth GS, Thurman D, Meador KJ, et al. Practice parameter update: management issues for women with epilepsy—focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency. Neurology. 2009;73(2):126–32.

    PubMed  CAS  Article  Google Scholar 

  203. 203.

    Jagoda A, Riggio S. Emergency department approach to managing seizures in pregnancy. Ann Emerg Med. 1991;20(1):80–5.

    PubMed  CAS  Article  Google Scholar 

  204. 204.

    Karnad DR, Guntupalli KK. Neurologic disorders in pregnancy. Crit Care Med. 2005;33(10):S362–71.

    PubMed  Article  Google Scholar 

  205. 205.

    Molgaard-Nielsen D. Newer-generation antiepileptic drugs and the risk of major birth defects. J Am Med Assoc. 2011;305(19):1996–2002.

    Article  Google Scholar 

  206. 206.

    Duley L, Henderson-Smart DJ, Chou D: Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev 2010(10):CD000128.

  207. 207.

    Appleton R, Choonara I, Martland T, Phillips B, Scott R, Whitehouse W. The treatment of convulsive status epilepticus in children. The status epilepticus working party, members of the status epilepticus working party. Arch Dis Child. 2000;83(5):415–9.

    PubMed  CAS  Article  Google Scholar 

  208. 208.

    Singhi S, Banerjee S, Singhi P. Refractory status epilepticus in children: role of continuous diazepam infusion. J Child Neurol. 1998;13(1):23–6.

    PubMed  CAS  Article  Google Scholar 

  209. 209.

    Vespa PM, Nuwer MR, Nenov V, Ronne-Engstrom E, Hovda DA, Bergsneider M, Kelly DF, Martin NA, Becker DP. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg. 1999;91(5):750–60.

    PubMed  CAS  Article  Google Scholar 

  210. 210.

    Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62(10):1743–8.

    PubMed  CAS  Article  Google Scholar 

  211. 211.

    Pandian JD, Cascino GD, So EL, Manno E, Fulgham JR. Digital video-electroencephalographic monitoring in the neurological-neurosurgical intensive care unit: clinical features and outcome. Arch Neurol. 2004;61(7):1090–4.

    PubMed  Article  Google Scholar 

  212. 212.

    Vespa PM, O’Phelan K, Shah M, Mirabelli J, Starkman S, Kidwell C, Saver J, Nuwer MR, Frazee JG, McArthur DA, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003;60(9):1441–6.

    PubMed  CAS  Article  Google Scholar 

  213. 213.

    Varelas PN, Hacein-Bey L, Hether T, Terranova B, Spanaki MV. Emergent electroencephalogram in the intensive care unit: indications and diagnostic yield. Clin EEG Neurosci. 2004;35(4):173–80.

    PubMed  Google Scholar 

  214. 214.

    Jordan KG. Neurophysiologic monitoring in the neuroscience intensive care unit. Neurol Clin. 1995;13(3):579–626.

    PubMed  CAS  Google Scholar 

  215. 215.

    Legriel S, Bruneel F, Sediri H, Hilly J, Abbosh N, Lagarrigue MH, Troche G, Guezennec P, Pico F, Bedos JP. Early EEG monitoring for detecting postanoxic status epilepticus during therapeutic hypothermia: a pilot study. Neurocrit Care. 2009;11(3):338–44.

    PubMed  Article  Google Scholar 

  216. 216.

    Hirsch LJ. Continuous EEG monitoring in the intensive care unit: an overview. J Clin Neurophysiol. 2004;21(5):332–40.

    PubMed  Google Scholar 

  217. 217.

    Shahwan A, Bailey C, Shekerdemian L, Harvey AS. The prevalence of seizures in comatose children in the pediatric intensive care unit: a prospective video-EEG study. Epilepsia. 2010;51(7):1198–204.

    PubMed  Article  Google Scholar 

  218. 218.

    Abend NS. Nonconvulsive seizures are common in critically ill children. Neurology. 2011;76(12):1071–7.

    PubMed  CAS  Article  Google Scholar 

  219. 219.

    Hahn CD. Nonconvulsive seizures among critically ill children: look and you shall find. Neurology. 2011;76(12):1036–7.

    PubMed  Article  Google Scholar 

  220. 220.

    Vespa PM, Miller C, McArthur D, Eliseo M, Etchepare M, Hirt D, Glenn TC, Martin N, Hovda D. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med. 2007;36(7):2218–9.

    Google Scholar 

  221. 221.

    Vulliemoz S, Perrig S, Pellise D, et al. Imaging compatible electrodes for continuous electroencephalogram monitoring in the intensive care unit. J Clin Neurophysiol. 2009;26(4):236–43.

    PubMed  Article  Google Scholar 

  222. 222.

    Ives J. New chronic EEG electrode for critical/intensive care unit monitoring. J Clin Neurophysiol. 2005;22(2):119–23.

    PubMed  Article  Google Scholar 

  223. 223.

    Vespa P. Continuous EEG monitoring for the detection of seizures in traumatic brain injury, infarction, and intracerebral hemorrhage: “to detect and to protect”. J Clin Neurophysiol. 2005;22(2):99–106.

    PubMed  Article  Google Scholar 

  224. 224.

    Vespa P, Prins M, Ronne-Engstrom E, Caron M, Shalmon E, Hovda DA, Martin NA, Becker DP. Increase in extracellular glutamate caused by reduced cerebral perfusion pressure and seizures after human traumatic brain injury: a microdialysis study. J Neurosurg. 1998;89(6):971–82.

    PubMed  CAS  Article  Google Scholar 

  225. 225.

    Vespa PM, McArthur D, O’Phelan K, Glenn T, Etchepare M, Kelly D, Bergsneider M, Martin NA, Hovda DA. Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: a microdialysis study. J Cereb Blood Flow Metab. 2003;23(7):865–77.

    PubMed  CAS  Article  Google Scholar 

  226. 226.

    Vespa P, McArthur DL, Glenn T, et al. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology. 2010;75(9):792–8.

    PubMed  CAS  Article  Google Scholar 

  227. 227.

    Claassen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. J Neurol Sci. 2003;211(1–2):37–41.

    PubMed  Article  Google Scholar 

  228. 228.

    Goodkin HP, Yeh JL, Kapur J. Status epilepticus increases the intracellular accumulation of GABAA receptors. J Neurosc: Off J Soc Neurosci. 2005;25(23):5511–20.

    CAS  Article  Google Scholar 

  229. 229.

    Naylor DE, Liu H, Wasterlain CG. Trafficking of GABA(A) receptors, loss of inhibition, and a mechanism for pharmacoresistance in status epilepticus. J Neurosc: Off J Soc Neurosci. 2005;25(34):7724–33.

    CAS  Article  Google Scholar 

  230. 230.

    Goodkin HR, Joshi S, Kozhemyakin M, Kapur J. Impact of receptor changes on treatment of status epilepticus. Epilepsia. 2007;48(Suppl 8):14–5.

    PubMed  Article  Google Scholar 

  231. 231.

    Goodkin HP, Buck ML. Still orphans: antiepileptic drug trials in children under 2 years of age. Neurology. 2008;70(22 Pt 2):2093–4.

    PubMed  Article  Google Scholar 

  232. 232.

    Meldrum BS. Excitatory amino acids in epilepsy and potential novel therapies. Epilepsy Res. 1992;12(2):189–96.

    PubMed  CAS  Article  Google Scholar 

  233. 233.

    Yen W, Williamson J, Bertram EH, Kapur J. A comparison of three NMDA receptor antagonists in the treatment of prolonged status epilepticus. Epilepsy Res. 2004;59(1):43–50.

    PubMed  CAS  Article  Google Scholar 

  234. 234.

    Lauritzen M. Clinical relevance of cortical spreading depression in neurological disorders: migraine, malignant stroke, subarachnoid and intracranial hemorrhage, and traumatic brain injury. J Cereb Blood Flow Metab. 2011;31(1):17–35.

    PubMed  Article  Google Scholar 

  235. 235.

    Hartings JA. Spreading depolarizations have prolonged direct current shifts and are associated with poor outcome in brain trauma. Brain. 2011;134(5):1529–40.

    PubMed  Article  Google Scholar 

  236. 236.

    Dohmen C. Spreading depolarizations occur in human ischemic stroke with high incidence. Ann Neurol. 2008;63(6):720–8.

    PubMed  Article  Google Scholar 

  237. 237.

    Dreier JP. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain. 2006;129(12):3224–37.

    PubMed  Article  Google Scholar 

  238. 238.

    Dreier JP, Major S, Pannek HW, Woitzik J, Scheel M, Wiesenthal D, Martus P, Winkler MK, Hartings JA, Fabricius M, et al. Spreading convulsions, spreading depolarization and epileptogenesis in human cerebral cortex. Brain. 2012;135(Pt 1):259–75.

    PubMed  Article  Google Scholar 

  239. 239.

    Fabricius M. Association of seizures with cortical spreading depression and peri-infarct depolarisations in the acutely injured human brain. Clin Neurophysiol. 2008;119(9):1973.

    PubMed  Article  Google Scholar 

  240. 240.

    Waziri A. Intracortical electroencephalography in acute brain injury. Annals of neurology. 2009;66(3):366–77.

    PubMed  Article  Google Scholar 

  241. 241.

    Treiman DM. The role of benzodiazepines in the management of status epilepticus. Neurology. 1990;40(5 Suppl 2):32–42.

    PubMed  CAS  Google Scholar 

  242. 242.

    Nei M, Lee J-M, Shanker VL, Sperling MR. The EEG and prognosis in status epilepticus. Epilepsia. 1999;40(2):157–63.

    PubMed  CAS  Article  Google Scholar 

  243. 243.

    Chen DK, So YT, Fisher RS. Use of serum prolactin in diagnosing epileptic seizures: report of the therapeutics and technology assessment subcommittee of the American academy of neurology. Neurology. 2005;65(5):668–75.

    PubMed  CAS  Article  Google Scholar 

  244. 244.

    DeGiorgio CM, Heck CN, Rabinowicz AL, Gott PS, Smith T, Correale J. Serum neuron-specific enolase in the major subtypes of status epilepticus. Neurology. 1999;52(4):746–9.

    PubMed  CAS  Article  Google Scholar 

  245. 245.

    Treiman DMGL, Marsh ST. Characterization of experimental status epilepticus by nonlinear dynamical analysis of the EEG. Epilepsia. 2005;46(Suppl 8):304.

    Google Scholar 

  246. 246.

    Hirsch LJ, Brenner RP, Drislane FW, So E, Kaplan PW, Jordan KG, Herman ST, LaRoche SM, Young B, Bleck TP, et al. The ACNS subcommittee on research terminology for continuous EEG monitoring: proposed standardized terminology for rhythmic and periodic EEG patterns encountered in critically ill patients. J Clin Neurophysiol. 2005;22(2):128–35.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The committee would like to recognize and thank the following experts (listed alphabetically) who reviewed the committee’s initial recommendations and provided changes that were incorporated into the final guideline: Aaron Cook, Jeffrey Frank, Jennifer Fugate, Kathleen Hubner, Andrew Kofke, Andreas H. Kramer, Marek Mirski, Andrea Rossetti, Robert Silbergleit, and Panayiotis N. Varelas.

Author information

Affiliations

Authors

Consortia

Corresponding author

Correspondence to Gretchen M. Brophy.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Brophy, G.M., Bell, R., Claassen, J. et al. Guidelines for the Evaluation and Management of Status Epilepticus. Neurocrit Care 17, 3–23 (2012). https://doi.org/10.1007/s12028-012-9695-z

Download citation

Keywords

  • Status epilepticus
  • Seizure
  • Guideline
  • EEG
  • Antiepileptic treatment