Advertisement

Intensive Care Management of Status Epilepticus

  • Stephane LegrielEmail author
Chapter

Abstract

Status epilepticus (SE) is defined as 5 min or more of continuous seizure activity (clinical and/or electrographic), or recurrent seizure activity without returning to baseline between seizures. SE is a major medical emergency associating a heterogeneous set of electro-clinical presentations, among which we distinguish SE with prominent motor symptoms, which is usually easy to recognize on clinical grounds, and SE without prominent motor symptoms, also called nonconvulsive SE (NCSE), in which the symptoms may be minimal or negative. Management of SE in the ICU concurrently combines symptomatic general measures, antiepileptic treatment appropriate for the electrical and clinical pattern in the patient initiated on an emergency basis. Investigations to identify and correct the cause of SE itself should be performed simultaneously. The use of continuous EEG monitoring is an important part of the management of SE. Here all these important elements are successively and methodically explained to help the bedside physicians for the intensive care management of status epilepticus.

Keywords

Status epilepticus Critical care Mechanical ventilation Anticonvulsants/therapeutic use Etiology Complications Emergencies Acute disease 

Notes

Conflicts of Interest

I have no conflicts of interest to declare.

References

  1. 1.
    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.PubMedGoogle Scholar
  2. 2.
    Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5(3):246–56.PubMedGoogle Scholar
  3. 3.
    Legriel S, Lemiale V, Schenck M, Chelly J, Laurent V, Daviaud F, et al. Hypothermia for neuroprotection in convulsive status epilepticus. N Engl J Med. 2016;375(25):2457–67.PubMedGoogle Scholar
  4. 4.
    Legriel S, Mourvillier B, Bele N, Amaro J, Fouet P, Manet P, et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med. 2008;34(3):476–80.PubMedGoogle Scholar
  5. 5.
    Legriel S, Azoulay E, Resche-Rigon M, Lemiale V, Mourvillier B, Kouatchet A, et al. Functional outcome after convulsive status epilepticus. Crit Care Med. 2010;38(12):2295–303.PubMedGoogle Scholar
  6. 6.
    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.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Sutter R, Kaplan PW, Ruegg S. Outcome predictors for status epilepticus--what really counts. Nat Rev Neurol. 2013;9(9):525–34.PubMedGoogle Scholar
  8. 8.
    Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011;10(10):922–30.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Shorvon S. Super-refractory status epilepticus: an approach to therapy in this difficult clinical situation. Epilepsia. 2011;52(Suppl 8):53–6.PubMedGoogle Scholar
  10. 10.
    Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain J Neurol. 2011;134(Pt 10):2802–18.Google Scholar
  11. 11.
    Chen JW, Naylor DE, Wasterlain CG. Advances in the pathophysiology of status epilepticus. Acta Neurol Scand Suppl. 2007;186:7–15.PubMedGoogle Scholar
  12. 12.
    DeLorenzo RJ, Garnett LK, Towne AR, Waterhouse EJ, Boggs JG, Morton L, et al. Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Epilepsia. 1999;40(2):164–9.PubMedGoogle Scholar
  13. 13.
    Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, 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.PubMedGoogle Scholar
  14. 14.
    Eriksson K, Metsaranta P, Huhtala H, Auvinen A, Kuusela AL, Koivikko M. Treatment delay and the risk of prolonged status epilepticus. Neurology. 2005;65(8):1316–8.PubMedGoogle Scholar
  15. 15.
    Treiman DM. Generalized convulsive status epilepticus in the adult. Epilepsia. 1993;34(Suppl 1):S2–11.PubMedGoogle Scholar
  16. 16.
    Wasterlain CG, Fujikawa DG, Penix L, Sankar R. Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia. 1993;34(Suppl 1):S37–53.PubMedGoogle Scholar
  17. 17.
    Engrand N, Crespel A. Pathophysiologic basis of status epilepticus. Rev Neurol. 2009;165(4):315–9. Bases physiopathologiques des etats de mal epileptiques.PubMedGoogle Scholar
  18. 18.
    Baldy-Moulinier M, Crespel A. Pathophysiology of epileptic seizures and status epilepticus. Ann Fr Anesth Reanim. 2001;20(2):97–107. Physiopathologie des crises et des etats de mal epileptiques.PubMedGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    Walton NY. Systemic effects of generalized convulsive status epilepticus. Epilepsia. 1993;34(Suppl 1):S54–8.PubMedGoogle Scholar
  21. 21.
    Watson C. Status epilepticus. Clinical features, pathophysiology, and treatment. West J Med. 1991;155(6):626–31.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Bilotta F, Giovannini F, Caramia R, Rosa G. Glycemia management in neurocritical care patients: a review. J Neurosurg Anesthesiol. 2009;21(1):2–9.PubMedGoogle Scholar
  23. 23.
    Meyfroidt G, Keenan DM, Wang X, Wouters PJ, Veldhuis JD, Van den Berghe G. Dynamic characteristics of blood glucose time series during the course of critical illness: effects of intensive insulin therapy and relative association with mortality. Crit Care Med. 2010;38(4):1021–9.PubMedGoogle Scholar
  24. 24.
    Liu Z, Gatt A, Mikati M, Holmes GL. Effect of temperature on kainic acid-induced seizures. Brain Res. 1993;631(1):51–8.PubMedGoogle Scholar
  25. 25.
    Lundgren J, Smith ML, Blennow G, Siesjo BK. Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Exp Brain Res. 1994;99(1):43–55.PubMedGoogle Scholar
  26. 26.
    Ingvar M, Siesjo BK. Local blood flow and glucose consumption in the rat brain during sustained bicuculline-induced seizures. Acta Neurol Scand. 1983;68(3):129–44.PubMedGoogle Scholar
  27. 27.
    Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus--report of the ILAE task force on classification of status Epilepticus. Epilepsia. 2015;56(10):1515–23.PubMedGoogle Scholar
  28. 28.
    DeLorenzo RJ, Waterhouse EJ, Towne AR, Boggs JG, Ko D, DeLorenzo GA, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.PubMedGoogle Scholar
  29. 29.
    Leitinger M, Trinka E, Gardella E, Rohracher A, Kalss G, Qerama E, et al. Diagnostic accuracy of the Salzburg EEG criteria for non-convulsive status epilepticus: a retrospective study. Lancet Neurol. 2016;15(10):1054–62.PubMedGoogle Scholar
  30. 30.
    Walker MC, Howard RS, Smith SJ, Miller DH, Shorvon SD, Hirsch NP. Diagnosis and treatment of status epilepticus on a neurological intensive care unit. QJM Int J Med. 1996;89(12):913–20.Google Scholar
  31. 31.
    Hingray C, El-Hage W, Duncan R, Gigineishvili D, Kanemoto K, Curt LaFrance W Jr, et al. Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: an international survey by the ILAE PNES task force-2nd revision. Epilepsia. 2018;59(1):203–14.PubMedGoogle Scholar
  32. 32.
    Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology. 2006;66(11):1730–1.PubMedGoogle Scholar
  33. 33.
    Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007;6(4):329–39.PubMedGoogle Scholar
  34. 34.
    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.PubMedGoogle Scholar
  35. 35.
    Brenner RP. EEG in convulsive and nonconvulsive status epilepticus. J Clin Neurophysiol. 2004;21(5):319–31.PubMedGoogle Scholar
  36. 36.
    Herman ST, Abend NS, Bleck TP, Chapman KE, Drislane FW, Emerson RG, et al. Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol. 2015;32(2):96–108.PubMedPubMedCentralGoogle Scholar
  37. 37.
    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.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, et al. 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.PubMedGoogle Scholar
  39. 39.
    Beuchat I, Novy J, Rossetti AO. Newer antiepileptic drugs in status epilepticus: prescription trends and outcomes in comparison with traditional agents. CNS Drugs. 2017;31(4):327–34.PubMedGoogle Scholar
  40. 40.
    Navarro V, Dagron C, Elie C, Lamhaut L, Demeret S, Urien S, et al. Prehospital treatment with levetiracetam plus clonazepam or placebo plus clonazepam in status epilepticus (SAMUKeppra): a randomised, double-blind, phase 3 trial. Lancet Neurol. 2016;15(1):47–55.PubMedGoogle Scholar
  41. 41.
    Strzelczyk A, Zollner JP, Willems LM, Jost J, Paule E, Schubert-Bast S, et al. Lacosamide in status epilepticus: systematic review of current evidence. Epilepsia. 2017;58(6):933–50.PubMedGoogle Scholar
  42. 42.
    Legriel S, Oddo M, Brophy GM. What’s new in refractory status epilepticus? Intensive Care Med. 2017;43(4):543–6.PubMedGoogle Scholar
  43. 43.
    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.PubMedGoogle Scholar
  44. 44.
    Cariou A, Payen JF, Asehnoune K, Audibert G, Botte A, Brissaud O, et al. Targeted temperature management in the ICU: guidelines from a French expert panel. Ann Intensive Care. 2017;7(1):70.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Chateauneuf AL, Moyer JD, Jacq G, Cavelot S, Bedos JP, Legriel S. Super-refractory status epilepticus: epidemiology, early predictors, and outcomes. Intensive Care Med. 2017;43(10):1532–4.PubMedGoogle Scholar
  46. 46.
    Meierkord H, Boon P, Engelsen B, Gocke K, Shorvon S, Tinuper P, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010;17(3):348–55.PubMedGoogle Scholar
  47. 47.
    Taniguchi G, Miyajima M, Watanabe M, Murata Y, Sone D, Watanabe Y, et al. Nonconvulsive status epilepticus in the elderly associated with newer antidepressants used at therapeutic doses: a report of three cases. Epilepsy Behav Case Rep. 2015;3:8–11.PubMedGoogle Scholar
  48. 48.
    Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M, et al. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. 2013;39(8):1337–51.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Service de Réanimation Polyvalente, Centre Hospitalier de VersaillesLe ChesnayFrance

Personalised recommendations