Status epilepticus, which is simultaneously a neurologic and systemic emergency, often results in significant disability and may be fatal. This article presents a pragmatic approach to the evaluation and management of status epilepticus in adults for the practicing clinician.
Rapid recognition, treatment respecting a written protocol, and careful attention to potential complications may limit sequelae. Studies aimed at earlier identification of etiologies in cryptogenic status epilepticus and improving the treatment of established status epilepticus are urgently needed to limit the development of refractoriness.
This article reviews the guidelines and up-to-date information on the use of both pharmacologic and nonpharmacologic therapies in status epilepticus and discusses the shifts in our understanding of the balance between the need for aggressive control of seizures and the risks of treatment. This article also presents a suggested approach to the evaluation and management of common types of status epilepticus and explores future directions.
Address correspondence to Dr Sara E. Hocker, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, email@example.com.
Relationship Disclosure: Dr Hocker has received personal compensation for travel and accommodation expenses from the London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures, and Dr Hocker’s institution receives compensation for her work as a consultant on the data and safety monitoring board of SAGE Therapeutics.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Hocker discusses the unlabeled/investigational use of lacosamide, levetiracetam, midazolam, propofol, and valproate sodium for the treatment of status epilepticus.