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Advancements in the critical care management of status epilepticus

Bauerschmidt, Andrew; Martin, Andrew; Claassen, Jan

Current Opinion in Critical Care: April 2017 - Volume 23 - Issue 2 - p 122–127
doi: 10.1097/MCC.0000000000000392
NEUROSCIENCE: Edited by Raimund Helbok
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Purpose of review Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus.

Recent findings Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing. There remains a lack of prospective randomized controlled trials comparing different treatment regimens. Recent data support further study of intravenous lacosamide as an urgent-control therapy, and ketamine and clobazam for refractory status epilepticus. Recent data support the use of continuous EEG to help guide treatment for all patients with refractory status epilepticus and to better understand epileptic activity that falls on the ictal–interictal continuum. Recent data also improve our understanding of the relationship between periodic epileptic activity and brain injury.

Summary Many treatments are available for status epilepticus and there are much new data guiding the use of specific agents. However, there continues to be a lack of prospective data supporting specific regimens, particularly in cases of refractory status epilepticus.

Division of Neurocritical Care, Department of Neurology, Columbia University, New York, New York, USA

Correspondence to Jan Claassen, MD, PhD, Division of Neurocritical Care, Department of Neurology, Columbia University, 177 Fort Washington Avenue, MHB 8 Center, Room 300, New York, NY 10032, USA. Tel: +1 212 305 7236; fax: +1 212 305 2792; e-mail: jc1439@columbia.edu

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