Skip to main content
SpringerLink
Log in

Intensive Care Management of Status Epilepticus

  • Chapter
  • First Online:
Textbook of Neuroanesthesia and Neurocritical Care

  • 1307 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sutter R, Kaplan PW, Ruegg S. Outcome predictors for status epilepticus--what really counts. Nat Rev Neurol. 2013;9(9):525–34.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  11. Chen JW, Naylor DE, Wasterlain CG. Advances in the pathophysiology of status epilepticus. Acta Neurol Scand Suppl. 2007;186:7–15.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  15. Treiman DM. Generalized convulsive status epilepticus in the adult. Epilepsia. 1993;34(Suppl 1):S2–11.

    Article  PubMed  Google Scholar 

  16. Wasterlain CG, Fujikawa DG, Penix L, Sankar R. Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia. 1993;34(Suppl 1):S37–53.

    Article  PubMed  Google Scholar 

  17. Engrand N, Crespel A. Pathophysiologic basis of status epilepticus. Rev Neurol. 2009;165(4):315–9. Bases physiopathologiques des etats de mal epileptiques.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  20. Walton NY. Systemic effects of generalized convulsive status epilepticus. Epilepsia. 1993;34(Suppl 1):S54–8.

    Article  PubMed  Google Scholar 

  21. Watson C. Status epilepticus. Clinical features, pathophysiology, and treatment. West J Med. 1991;155(6):626–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  24. Liu Z, Gatt A, Mikati M, Holmes GL. Effect of temperature on kainic acid-induced seizures. Brain Res. 1993;631(1):51–8.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  32. Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology. 2006;66(11):1730–1.

    Article  PubMed  Google Scholar 

  33. Meierkord H, Holtkamp M. Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol. 2007;6(4):329–39.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  35. Brenner RP. EEG in convulsive and nonconvulsive status epilepticus. J Clin Neurophysiol. 2004;21(5):319–31.

    PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  42. Legriel S, Oddo M, Brophy GM. What’s new in refractory status epilepticus? Intensive Care Med. 2017;43(4):543–6.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflicts of Interest

I have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Service de Réanimation Polyvalente, Centre Hospitalier de Versailles, Le Chesnay, France

    Stephane Legriel

Authors
  1. Stephane Legriel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephane Legriel .

Editor information

Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Division of Neuroanesthesiology, Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India

    Zulfiqar Ali

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Legriel, S. (2019). Intensive Care Management of Status Epilepticus. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3390-3_7

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-3390-3_7

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-3389-7

  • Online ISBN: 978-981-13-3390-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation