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Status Epilepticus

Hirsch, Lawrence J. MD, FAAN; Gaspard, Nicolas MD, PhD

CONTINUUM: Lifelong Learning in Neurology: June 2013 - Volume 19 - Issue 3, Epilepsy - p 767–794
doi: 10.1212/01.CON.0000431395.16229.5a
Review Articles

Purpose of Review: This review presents the state of the art in the diagnosis and management of status epilepticus.

Recent Findings: In addition to general background, this article presents the most recent findings regarding the diagnosis and treatment of status epilepticus, including the results of the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) and the available data on the use of newer antiepileptic and anesthetic drugs in the treatment of refractory status epilepticus. It also presents available guidelines such as those from the Neurocritical Care Society.

Summary: Despite recent advances, the management of status epilepticus remains a challenge. Rapid treatment, a written treatment protocol, early consideration of nonconvulsive seizures, and avoiding overtreatment and medical complications are the keys to successful management. This article summarizes the current evidence and guidelines.

Address correspondence to Dr Lawrence J. Hirsch, Yale University School of Medicine, 15 York St, LLCI-714, New Haven, CT 06510, lawrence.hirsch@yale.edu.

Relationship Disclosure: Dr Hirsch serves as a consultant for GlaxoSmithKline, Lundbeck, and Upsher-Smith Laboratories, Inc, and receives research support from Lundbeck, UCB, and Upsher-Smith Laboratories, Inc. Dr Gaspard has received research support from the Belgian American Educational Foundation, Inc; the Belgian Neurological Society; the Epilepsy Foundation; and the Fulbright Commission for Education Exchange Between the United States, Belgium and Luxembourg.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Hirsch and Gaspard discuss the unlabeled use of electroconvulsive therapy, etomidate, felbamate, gabapentin, hypothermia, intravenous immunoglobulins, ketamine, ketogenic diet, lacosamide, levetiracetam, lidocaine, plasma exchange, pregabalin, steroids, topiramate, valproate, and vigabatrin for the treatment of status epilepticus.

© 2013 American Academy of Neurology