Abstract
Status epilepticus (SE) still results in significant mortality and morbidity. Whereas mortality depends mainly on the age of the patient as well as the cause, morbidity is often due to the myriad of complications that occur during prolonged admission to an intensive care environment. Although SE is a clinical diagnosis in most cases (convulsant), its treatment requires support by continuous electroencephalographic recording to ensure cessation of potential nonconvulsive elements of SE. Treatment has recently changed to incorporate four stages and must be initiated at the earliest possible time.
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Varelas PN, Mirski MA. Status epilepticus. Curr Neurol Neurosci Rep. 2009;9:469–76.
Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010;17:348–55.
•• Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3–23. These are latest guidelines from a large writing group representing the Neurocritical Care Society and using the GRADE system.
Gastaut H. Classification of status epilepticus. Adv Neurol. 1983;34:15–35.
Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America's Working Group on status epilepticus. JAMA. 1993;270:854–9.
Lowenstein DH, Bleck T, Macdonald RL. It's time to revise the definition of status epilepticus. Epilepsia. 1999;40:120–2.
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;47:1499–503.
Goodkin HP, Kapur J. Responsiveness of status epilepticus to treatment with diazepan decreases rapidly as seizure duration increases. Epilepsy Curr. 2003;3:11–2.
Lowenstein DH. The management of refractory status epilepticus: an update. Epilepsia. 2006;47 Suppl 1:35–40.
Shorvon S. What is nonconvulsive status epilepticus, and what are its subtypes? Epilepsia. 2007;48 Suppl 8:35–8.
Kaplan PW. Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is underdiagnosed, potentially overtreated, and confounded by comorbidity. J Clin Neurophysiol. 1999;16:341–52.
Walker MC. Diagnosis and treatment of nonconvulsive status epilepticus. CNS Drugs. 2001;15:931–9.
Kaplan PW. EEG criteria for nonconvulsive status epilepticus. Epilepsia. 2007;48 Suppl 8:39–41.
Sutter R, Kaplan PW. Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia. 2012;53 Suppl 3:1–51.
• Trinka E, Hofler J, Zerbs A. Causes of status epilepticus. Epilepsia. 2012;53 Suppl 4:127–38. This is a comprehensive review of the causes of SE.
Hauser WA. Status epilepticus: epidemiologic considerations. Neurology. 1990;40:9–13.
DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46:1029–35.
Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998;339:792–8.
Jordan KG. Nonconvulsive status epilepticus in acute brain injury. J Clin Neurophysiol. 1999;16:332–40. discussion 353.
Carrera E, Michel P, Despland PA, et al. Continuous assessment of electrical epileptic activity in acute stroke. Neurology. 2006;67:99–104.
Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54:340–5.
Claassen J, Jette N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology. 2007;69:1356–65.
Claassen J, Peery S, Kreiter KT, et al. Predictors and clinical impact of epilepsy after subarachnoid hemorrhage. Neurology. 2003;60:208–14.
Cocito L, Audenino D, Primavera A. Altered mental state and nonconvulsive status epilepticus in patients with cancer. Arch Neurol. 2001;58:1310.
Vespa PM, Nuwer MR, Nenov V, et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg. 1999;91:750–60.
Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol. 2002;59:205–10.
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;76:534–9.
• Novy J, Logroscino G, Rossetti AO. Refractory status epilepticus: a prospective observational study. Epilepsia. 2010;51:251–6. This is a prospective study of RSE outcomes.
Wijdicks EF, Sharbrough FW. New-onset seizures in critically ill patients. Neurology. 1993;43:1042–4.
Bleck TP, Smith MC, Pierre-Louis SJ, Jares JJ, Murray J, Hansen CA. Neurologic complications of critical medical illnesses. Crit Care Med. 1993;21:98–103.
Drislane FW, Lopez MR, Blum AS, Schomer DL. Detection and treatment of refractory status epilepticus in the intensive care unit. J Clin Neurophysiol. 2008;25:181–6.
Bauer G, Trinka E. Nonconvulsive status epilepticus and coma. Epilepsia. 2010;51:177–90.
Tan RY, Neligan A, Shorvon SD. The uncommon causes of status epilepticus: a systematic review. Epilepsy Res. 2010;91:111–22.
Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med. 1998;338:970–6.
Millikan D, Rice B, Silbergleit R. Emergency treatment of status epilepticus: current thinking. Emerg Med Clin North Am. 2009;27:101–1.
Fountain NB. Status epilepticus: risk factors and complications. Epilepsia. 2000;41 Suppl 2:S23–30.
Aminoff MJ, Simon RP. Status epilepticus. Causes, clinical features and consequences in 98 patients. Am J Med. 1980;69:657–66.
Loscher W. Mechanisms of drug resistance in status epilepticus. Epilepsia. 2007;48 Suppl 8:74–7.
Bankstahl JP, Loscher W. Resistance to antiepileptic drugs and expression of P-glycoprotein in two rat models of status epilepticus. Epilepsy Res. 2008;82:70–85.
DeLorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39:833–40.
Brenner RP. Is it status? Epilepsia. 2002;43 Suppl 3:103–13.
Kaplan PW. The EEG of status epilepticus. J Clin Neurophysiol. 2006;23:221–9.
Pedersen GL, Rasmussen SB, Gyllenborg J, Benedek K, Lauritzen M. Prognostic value of periodic electroencephalographic discharges for neurological patients with profound disturbances of consciousness. Clin Neurophysiol. 2013;124:44–51.
• Irani SR, Michell AW, Lang B, et al. Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol. 2011;69:892–900. This is an important article describing a new seizure entity with important implications.
Irani SR, Vincent A, Schott JM. Autoimmune encephalitis. BMJ. 2011;342:d1918.
Varelas PN, Spanaki MV. Management of status epilepticus and critical care seizures. In: Varelas PN, editor. Seizures in critical care. A guide to diagnosis and treatment. New York: Humana; 2010. p. 355–422.
Cook AM, Castle A, Green A, et al. Practice variations in the management of status epilepticus. Neurocrit Care. 2012;17:24–30.
Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345:631–7.
Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366:591–600.
•• Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011;134:2802–18. This is a comprehensive review of treatments available for SE.
Shorvon S, Ferlisi M. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain. 2012;135:2314–28.
McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet. 2005;366:205–10.
Misra UK, Kalita J, Maurya PK. Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled pilot study. J Neurol. 2012;259:645–8.
Agarwal P, Kumar N, Chandra R, Gupta G, Antony AR, Garg N. Randomized study of intravenous valproate and phenytoin in status epilepticus. Seizure. 2007;16:527–32.
Zelano J, Kumlien E. Levetiracetam as alternative stage two antiepileptic drug in status epilepticus: a systematic review. Seizure. 2012;21:233–6.
Trinka E. What is the evidence to use new intravenous AEDs in status epilepticus? Epilepsia. 2011;52 Suppl 8:35–8.
Alvarez V, Januel JM, Burnand B, Rossetti AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011;52:1292–6.
Hofler J, Trinka E. Lacosamide as a new treatment option in status epilepticus. Epilepsia. 2013;
Towne AR, Garnett LK, Waterhouse EJ, Morton LD, DeLorenzo RJ. The use of topiramate in refractory status epilepticus. Neurology. 2003;60:332–4.
Hottinger A, Sutter R, Marsch S, Ruegg S. Topiramate as an adjunctive treatment in patients with refractory status epilepticus: an observational cohort study. CNS Drugs. 2012;26:761–72.
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. 2012;16:109–13.
Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43:146–53.
Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40:759–62.
Treiman DM. Convulsive status epilepticus. Curr Treat Options Neurol. 1999;1:359–69.
Krishnamurthy KB, Drislane FW. Relapse and survival after barbiturate anesthetic treatment of refractory status epilepticus. Epilepsia. 1996;37:863–7.
Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol. 2005;62:1698–702.
Kramer AH. Early ketamine to treat refractory status epilepticus. Neurocrit Care. 2012;16:299–305.
Synowiec AS, Singh DS, Yenugadhati V, Valeriano JP, Schramke CJ, Kelly KM. Ketamine use in the treatment of refractory status epilepticus. Epilepsy Res. 2013. doi:10.1016/j.eplepsyres.2013.01.007.
Schulze-Bonhage A, Kurthen M, Walger P, Elger CE. Pharmacorefractory status epilepticus due to low vitamin B6 levels during pregnancy. Epilepsia. 2004;45:81–4.
Kluger G, Blank R, Paul K, et al. Pyridoxine-dependent epilepsy: normal outcome in a patient with late diagnosis after prolonged status epilepticus causing cortical blindness. Neuropediatrics. 2008;39:276–9.
Minns AB, Ghafouri N, Clark RF. Isoniazid-induced status epilepticus in a pediatric patient after inadequate pyridoxine therapy. Pediatr Emerg Care. 2010;26:380–1.
Visser NA, Braun KP, Leijten FS, van Nieuwenhuizen O, Wokke JH, van den Bergh WM. Magnesium treatment for patients with refractory status epilepticus due to POLG1-mutations. J Neurol. 2011;258:218–22.
Iannetti P, Spalice A, Parisi P. Calcium-channel blocker verapamil administration in prolonged and refractory status epilepticus. Epilepsia. 2005;46:967–9.
Iannetti P, Parisi P, Spalice A, Ruggieri M, Zara F. Addition of verapamil in the treatment of severe myoclonic epilepsy in infancy. Epilepsy Res. 2009;85:89–95.
Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008;9:189–97.
Rossetti AO. What is the value of hypothermia in acute neurologic diseases and status epilepticus? Epilepsia. 2011;52 Suppl 8:64–6.
Sierra-Marcos A, Maestro I, Rodriguez-Osorio X, et al. Successful outcome of episodes of status epilepticus after vagus nerve stimulation: a multicenter study. Eur J Neurol. 2012;19:1219–23.
Walker MC. The potential of brain stimulation in status epilepticus. Epilepsia. 2011;52 Suppl 8:61–3.
Lambrecq V, Villega F, Marchal C, et al. Refractory status epilepticus: electroconvulsive therapy as a possible therapeutic strategy. Seizure. 2012;21:661–4.
Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia. 1994;35:27–34.
DeLorenzo RJ, Towne AR, Pellock JM, Ko D. Status epilepticus in children, adults, and the elderly. Epilepsia. 1992;33 Suppl 4:S15–25.
Legriel S, Mourvillier B, Bele N, et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med. 2008;34:476–80.
Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology. 2009;72:744–9.
Hocker SE, Britton JW, Mandrekar JN, Wijdicks EF, Rabinstein AA. Predictors of outcome in refractory status epilepticus. JAMA Neurol. 2013;70:72–7.
Rossetti AO, Logroscino G, Bromfield EB. A clinical score for prognosis of status epilepticus in adults. Neurology. 2006;66:1736–8.
Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB. Status Epilepticus Severity Score (STESS): a tool to orient early treatment strategy. J Neurol. 2008;255:1561–6.
Hesdorffer DC, Logroscino G, Cascino GD, Hauser WA. Recurrence of afebrile status epilepticus in a population-based study in Rochester, Minnesota. Neurology. 2007;69:73–8.
Varelas PN, Mirski MA. Seizures in the adult intensive care unit. J Neurosurg Anesthesiol. 2001;13:163–75.
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Panayiotis N. Varelas declares no conflict of interest.
Marianna V. Spanaki declares no conflict of interest.
Marek A. Mirski declares no conflict of interest.
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Varelas, P.N., Spanaki, M.V. & Mirski, M.A. Status Epilepticus: An Update. Curr Neurol Neurosci Rep 13, 357 (2013). https://doi.org/10.1007/s11910-013-0357-0
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DOI: https://doi.org/10.1007/s11910-013-0357-0