Over the last 2 years, algorithms for the optimal management of status epilepticus have changed, as the medical community has recognized the need to terminate seizures in status in a timely manner. Recent research has evaluated the different choices of benzodiazepine and has given consideration to second-line treatment options.
There has been a move to examine alternatives to phenytoin (such as levetiracetam and lacosamide) as second-line agents. Valproate should be used cautiously in view of the potential side effects. Three ongoing trials [Established Staus Epilepticus Treatment Trial (ESETT), Convulsive Status Epilepticus Paediatric Trial (ConSEPT), and emergency treatment with levetiracetam or phenytoin in status epilepticus in children (EcLiPSE)] are comparing the efficacy of levetiracetam and phenytoin.
Benzodiazepines remain the first-line agent of choice, although there is ongoing discussion about the mode of administration and the best drug to choose. The results of ESETT, ConSEPT, and EcLiPSE will affect our future management of status, as we give consideration to levetiracetam as an alternative to phenytoin. Other medications such as lacosamide may emerge in future algorithms too.
aEmergency Department, Lady Cilento Children's Hospital, South Brisbane
bEmergency Department, School of Medicine, University of Queensland, St Lucia
cEmergency Department, Logan Hospital, Meadowbrook, Queensland, Australia
dEmergency Department, Royal London Hospital, London, UK
eEmergency Department, Footscray Hospital, Melbourne, Victoria, Australia
Correspondence to Ben Lawton, BSc (Hons), MBChB, FRACP (PEM), Emergency Department, Logan Hospital, Armstrong Rd. & Loganlea Rd., Meadowbrook 4131, QLD, Australia. E-mail: firstname.lastname@example.org