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Convulsive status epilepticus

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Opinion statement

Generalized convulsive status epilepticus (GCSE) is a medical emergency that must be treated rapidly and aggressively to prevent neuronal damage. Treatment should be initiated with intravenous lorazepam, 0.1 mg/kg, given at a rate of no more than 2 mg/min. If convulsions persist for more than 10 minutes or recur more than 20 minutes after lorazepam therapy is started, then fosphenytoin (20 mg of phenytoin equivalents per kilogram) should be infused at a rate of no more than 150 mg/min. If convulsions still continue, intravenous general anesthesia with pentobarbital, benzodiazepine drip, or propofol should be initiated after respiratory support has been established. All patients with GCSE who do not recover consciousness should be monitored with electroencephalography (EEG), and any residual epileptiform activity on EEG, including periodic epileptiform discharges (PEDs), should be considered evidence of continuing GCSE and treated aggressively.

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References and Recommended Reading

  1. Kinnier-Wilson JV, Reynolds EH: Translation and analysis of a cuneiform text forming part of a Babylonian treatise on epilepsy. Med Hist 1990, 34:185–198.

    Google Scholar 

  2. Calmeil J: De l’épilepsie, étudiée sous le rapport de son siège et de son influence sur la production de l’aliénation mentale [thesis]. Paris: Université de Paris; 1824.

    Google Scholar 

  3. Clark LP, Prout TP: Status epilepticus: a clinical and pathological study in epilepsy. Am J Insanity 1904, 60:645–699.

    Google Scholar 

  4. Clark LP, Prout TP: Status epilepticus: a clinical and pathological study in epilepsy. Am J Insanity 1904, 61:81–108.

    Google Scholar 

  5. Gastaut H, Roger J, Lob H, et al.: Les états de mal épileptiques. Paris: Masson; 1967.

    Google Scholar 

  6. Treiman DM: Generalized convulsive status epilepticus in the adult. Epilepsia 1993, 34(suppl 1):S2-S11.

    PubMed  Google Scholar 

  7. Treiman DM, Walton NY, Kendrick C: A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res 1990, 5:49–60. This is the first report of a predictable sequence of changes on electroencephalography in generalized convulsive status epilepticus (GCSE). Identification of this sequence has been important in increasing understanding of the dynamic nature of GCSE in both experimental and clinical studies.

    Article  PubMed  CAS  Google Scholar 

  8. Treiman DM, Meyers PD, Walton NY, et al.: Duration of generalized convulsive status epilepticus: relationship to clinical symptomatology and response to treatment [abstract]. Epilepsia 1992, 33(suppl 3):66.

    Google Scholar 

  9. Treiman DM, Meyers PD, DVA Status Epilepticus Cooperative Study Group: Utility of the EEG pattern as a predictor of success in the treatment of generalized convulsive status epilepticus [abstract]. Epilepsia 1991, 32(suppl 3):93.

    Google Scholar 

  10. Hauser WA: Status epilepticus: epidemiologic considerations. Neurology 1990, 40(suppl 2):9–13. This study of the epidemiology of status epilepticus, done in Rochester, Minnesota, provides much-needed information about the causes and consequences of the disorder.

    PubMed  CAS  Google Scholar 

  11. DeLorenzo RJ, Hauser WA, Towne AR, et al.: A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996, 46:1029–1035. This study of the epidemiology of status epilepticus, done in Richmond, Virginia, provides much-needed information about the causes and consequences of the disorder.

    PubMed  CAS  Google Scholar 

  12. Treiman DM, Meyers PD, Walton NY, et al.: A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med 1998, 339:792–798. This is the first and only large-scale randomized blinded comparison of established drugs for the treatment of generalized convulsive status epilepticus. It validates the position of lorazepam as the favored agent in the initial management of the disorder.

    Article  PubMed  CAS  Google Scholar 

  13. Treiman DM, Delgado-Escueta AV: Status epilepticus. In Critical Care of Neurological and Neurosurgical Emergencies. Edited by Thompson RA, Green JR. New York: Raven Press; 1980:53–99.

    Google Scholar 

  14. Craven W, Faught E, Kuzniecky R, et al.: Residual electrographic status epilepticus after control of overt clinical seizures [abstract]. Epilepsia 1995, 36(suppl 4):46.

    Google Scholar 

  15. Lipton SA, Rosenberg PA: Mechanisms of disease: excitatory amino acids as a final common pathway for neurologic disorders. N Engl J Med 1994, 330:613–622.

    Article  PubMed  CAS  Google Scholar 

  16. Meldrum B: Excitotoxicity and epileptic brain damage. Epilepsy Res 1991, 10:55–61.

    Article  PubMed  CAS  Google Scholar 

  17. Meldrum BS: Excitotoxicity and selective neuronal loss in epilepsy. Brain Pathol 1993, 3:405–412.

    PubMed  CAS  Google Scholar 

  18. Rothman SM, Olney JW: Excitotoxicity and the NMDA receptor. Trends Neurosci 1987, 10:299–304.

    Article  CAS  Google Scholar 

  19. Treiman DM: Current treatment strategies in selected situations in epilepsy. Epilepsia 1993, 34(suppl 5):S17-S23.

    PubMed  Google Scholar 

  20. Blennow G, Brierley JB, Meldrum BS, et al.: Epileptic brain damage: the role of systemic factors that modify cerebral energy metabolism. Brain 1978, 101:687–700.

    Article  PubMed  CAS  Google Scholar 

  21. Melamed E: Reactive hyperglycemia in patients with acute stroke. J Neurol Sci 1976, 29:267–275.

    Article  PubMed  CAS  Google Scholar 

  22. Pulsinelli WA, Levy DE, Sigsbee B, et al.: Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus. Am J Med 1983, 74:540–544.

    Article  PubMed  CAS  Google Scholar 

  23. Greenblatt DJ, Divoll M: Diazepam versus lorazepam: relationship of drug distribution to duration of clinical action. In Status Epilepticus: Mechanisms of Brain Damage and Treatment. Edited by Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ. New York: Raven Press; 1983:487–491.

    Google Scholar 

  24. Delgado-Escueta AV, Wasterlain C, Treiman DM, et al.: Current concepts in neurology: management of status epilepticus. N Engl J Med 1982, 306:1337–1340.

    Article  PubMed  CAS  Google Scholar 

  25. O’Brien TJ, Cascino GD, So EL, et al.: Incidence and clinical consequence of the purple glove syndrome in patients receiving intravenous phenytoin. Neurology 1998, 51:1034–1039. This important study documents that purple-glove syndrome, a devastating complication of intravenous phenytoin therapy, is far more common than previously appreciated.

    PubMed  CAS  Google Scholar 

  26. Marchetti A, Magar R, Fischer J, et al.: A pharmacoeconomic evaluation of intravenous fosphenytoin (Cerebyx) versus intravenous phenytoin (Dilantin) in hospital emergency departments. Clin Ther 1996, 18:953–966.

    Article  PubMed  CAS  Google Scholar 

  27. Stecker MM, Kramer TH, Raps EC, et al.: Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia 1998, 39:18–26.

    Article  PubMed  CAS  Google Scholar 

  28. Brown LA, Levin GM: Role of propofol in refractory status epilepticus [review]. Ann Pharmacother 1998, 32:1053–1059.

    Article  PubMed  CAS  Google Scholar 

  29. Fischer JH, Raineri DL: Pentobarbital anesthesia for status epilepticus. Clin Pharmacol 1987, 6:601–602.

    CAS  Google Scholar 

  30. Mirski MA, Williams MA, Hanley DF: Prolonged pentobarbital and phenobarbital coma for refractory generalized status epilepticus. Crit Care Med 1995, 23:400–404.

    Article  PubMed  CAS  Google Scholar 

  31. Rashkin MC, Youngs C, Penovich P: Pentobarbital treatment of refractory status epilepticus. Neurology 1987, 37:500–503.

    PubMed  CAS  Google Scholar 

  32. Van Ness PC: Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin. Epilepsia 1990, 31:61–67.

    PubMed  Google Scholar 

  33. Yaffe K, Lowenstein DH: Prognostic factors of pentobarbital therapy for refractory generalized status epilepticus. Neurology 1993, 43:895–900.

    PubMed  CAS  Google Scholar 

  34. Young GB, Blume WT, Bolton CF, et al.: Anesthetic barbiturates in refractory status epilepticus. Can J Neurol Sci 1980, 7:291–292.

    PubMed  CAS  Google Scholar 

  35. Kumar A, Bleck TP: Intravenous midazolam for the treatment of refractory status epilepticus. Crit Care Med 1992, 20:483–488.

    Article  PubMed  CAS  Google Scholar 

  36. Parent JM, Lowenstein DH: Treatment of refractory generalized status epilepticus with continuous infusion of midazolam. Neurology 1994, 44:1837–1840.

    PubMed  CAS  Google Scholar 

  37. Rivera R, Segnini M, Baltodano A, et al.: Midazolam in the treatment of status epilepticus in children. Crit Care Med 1993, 21:991–994.

    Article  PubMed  CAS  Google Scholar 

  38. Bertz RJ, Howrie DL: Diazepam by continuous intravenous infusion for status epilepticus in anticonvulsant hypersensitivity syndrome. Ann Pharmacother 1993, 27:298–301.

    PubMed  CAS  Google Scholar 

  39. Walker MC, Smith SJ, Shorvon SD: The intensive care treatment of convulsive status epilepticus in the UK. Results of a national survey and recommendations. Anaesthesia 1995, 50:130–135.

    Article  PubMed  CAS  Google Scholar 

  40. Labar DR, Ali A, Root J: High-dose intravenous lorazepam for the treatment of refractory status epilepticus. Neurology 1994, 44:1400–1403.

    PubMed  CAS  Google Scholar 

  41. Walton NY, Treiman DM: Valproic acid treatment of experimental status epilepticus. Epilepsy Res 1992, 12:199–205.

    Article  PubMed  CAS  Google Scholar 

  42. Czapinski P, Terczynski A: [Intravenous valproic acid administration in status epilepticus] [Polish]. Neurol Neurochir Pol 1998, 32:11–22.

    PubMed  CAS  Google Scholar 

  43. Walton NY, Treiman DM: Rational polytherapy in the treatment of status epilepticus. In Rational Polypharmacy. Edited by Leppik IE, Homan RW. Amsterdam: Elsevier; 1996:123–139.

    Google Scholar 

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  1. Department of Neurology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 97 Paterson Street, 08901, New Brunswick, NJ, USA

    David M. Treiman MD

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Treiman, D.M. Convulsive status epilepticus. Curr Treat Options Neurol 1, 359–369 (1999). https://doi.org/10.1007/s11940-999-0025-5

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