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Status epilepticus

Status epilepticus

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Zusammenfassung

Der Status epilepticus (SE) ist ein medizinischer Notfall. Für die Diagnose des SE ist das EEG notwendig, wenn motorische Entäußerungen nicht vorhanden sind oder wenn ein einzelner Anfall in einen SE übergeht, bei dem das Bewusstsein gestört ist. Im EEG können fokale und generalisierte Statusmuster auftreten, die von EEG-Veränderungen bei Enzephalopathien abgegrenzt werden müssen. Therapeutisch stehen in der Initialphase Benzodiazepine zur Verfügung, wobei Lorazepam das Mittel der Wahl ist. Wenn damit der SE nicht unterbrochen werden kann, folgt eine Therapie mit Phenytoin, Valproat, Levetiracetam, Lacosamid oder Phenobarbital. Die Auswahl wird maßgeblich von den zugrunde liegenden Komorbiditäten bestimmt. Zugelassen in dieser Phase ist lediglich Phenytoin. Wenn es sich um einen generalisiert tonisch-klonischen Status handelt, erfolgt die Einleitung einer Narkose mit Midazolam, Disoprovan oder Thiopental, wenn Therapieresistenz besteht. Ziel ist das Erreichen einer Burst-Suppression im EEG und die Aufsättigung mit Antiepileptika.

Summary

Status epilepticus (SE) is a medical emergency. For diagnostic purposes EEG is mandatory when motor phenomena are absent or when a single seizure evolves into SE with impaired consciousness. The EEG may show focal or generalized status patterns, which must be distinguished from encephalopathies. Initially benzodiazepines are recommended; lorazepam is the drug of choice. When the SE persists, phenytoin, valproate, levetiracetam, lacosamide, and phenobarbital are administered. The choice depends on the underlying comorbidities. In this phase, only phenytoin is licensed. A generalized tonic-clonic status which is refractory is then treated with anesthetics including midazolam, disoprivan, or thiopental. The goal is to achieve burst suppression in the EEG and coadministration of antiepileptic drugs.

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Authors and Affiliations

  1. Epilepsie-Zentrum, Neurologische Klinik, Klinikum der Universität München – Großhadern, Marchioninistr.15, 81377, München, Deutschland

    B. Feddersen

  2. Universitätsklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medizinische Privatuniversität Salzburg, Ignaz-Harrer-Str. 79, 5020, Salzburg, Österreich

    E. Trinka

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  1. B. Feddersen
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  2. E. Trinka
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Correspondence to B. Feddersen or E. Trinka.

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Feddersen, B., Trinka, E. Status epilepticus. Nervenarzt 83, 187–194 (2012). https://doi.org/10.1007/s00115-011-3337-0

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