PDF herunterladen
CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2019; 06(03): 267-274
DOI: 10.1055/s-0039-1700446
Review Article
Indian Society of Neuroanaesthesiology and Critical Care

Management of Status Epilepticus

Ritesh Lamsal
1   Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Nepal
,
Navindra R. Bista
1   Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Nepal
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received: 20. August 2019

Accepted after revision: 17. September 2019

Publikationsdatum:
21. November 2019 (online)

   Lizenzen und Reprints

Abstract

Status epilepticus (SE) is a life-threatening neurologic condition that requires immediate assessment and intervention. Over the past few decades, the duration of seizure required to define status epilepticus has shortened, reflecting the need to start therapy without the slightest delay. The focus of this review is on the management of convulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment of both forms of status epilepticus includes immediate assessment and stabilization, and administration of rapidly acting benzodiazepine therapy followed by nonbenzodiazepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and SRSE) pose a lot of therapeutic problems, necessitating the administration of continuous infusion of high doses of anesthetic agents, and carry a high risk of debilitating morbidity as well as mortality.

Keywords

convulsive status epilepticus - neurocritical care - nonconvulsive status epilepticus - refractory status epilepticus - status epilepticus - super-refractory status epilepticus
 

  • References

  • 1 Brodie MJ. Status epilepticus in adults. Lancet 1990; 336 (8714) 551-552
    CrossrefPubMedGoogle Scholar
  • 2 Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia 1999; 40 (01) 120-122
    CrossrefPubMedGoogle Scholar
  • 3 Trinka E, Cock H, Hesdorffer D. et al. A definition and classification of status epilepticus–Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia 2015; 56 (10) 1515-1523
    CrossrefPubMedGoogle Scholar
  • 4 Kantanen AM, Reinikainen M, Parviainen I. et al. Incidence and mortality of super-refractory status epilepticus in adults. Epilepsy Behav 2015; 49: 131-134
    CrossrefPubMedGoogle Scholar
  • 5 Hirsch LJ, Gaspard N, van Baalen A. et al. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia 2018; 59 (04) 739-744
    CrossrefPubMedGoogle Scholar
  • 6 Brophy GM, Bell R, Claassen J. et al. Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17 (01) 3-23
    CrossrefPubMedGoogle Scholar
  • 7 Navarro V, Dagron C, Elie C. et al. SAMUKeppra investigators. Prehospital treatment with levetiracetam plus clonazepam or placebo plus clonazepam in status epilepticus (SAMUKeppra): a randomised, double-blind, phase 3 trial. Lancet Neurol 2016; 15 (01) 47-55
    CrossrefPubMedGoogle Scholar
  • 8 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 (09) 631-637
    CrossrefPubMedGoogle Scholar
  • 9 Sreenath TG, Gupta P, Sharma KK, Krishnamurthy S. Lorazepam versus diazepam-phenytoin combination in the treatment of convulsive status epilepticus in children: a randomized controlled trial. Eur J Paediatr Neurol 2010; 14 (02) 162-168
    CrossrefPubMedGoogle Scholar
  • 10 Treiman DM, Meyers PD, Walton NY. et al. Veterans Affairs Status Epilepticus Cooperative Study Group. A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med 1998; 339 (12) 792-798
    CrossrefPubMedGoogle Scholar
  • 11 Anderson M, Tambe P, Sammons H, Mulla H, Cole R, Choonara I. Pharmacokinetics of buccal and intranasal lorazepam in healthy adult volunteers. Eur J Clin Pharmacol 2012; 68 (02) 155-159
    CrossrefPubMedGoogle Scholar
  • 12 Arya R, Gulati S, Kabra M, Sahu JK, Kalra V. Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. Epilepsia 2011; 52 (04) 788-793
    CrossrefPubMedGoogle Scholar
  • 13 Chamberlain JM, Okada P, Holsti M. et al. Pediatric Emergency Care Applied Research Network (PECARN). Lorazepam vs diazepam for pediatric status epilepticus: a randomized clinical trial. JAMA 2014; 311 (16) 1652-1660
    CrossrefPubMedGoogle Scholar
  • 14 Silbergleit R, Durkalski V, Lowenstein D. et al. NETT Investigators. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366 (07) 591-600
    CrossrefPubMedGoogle Scholar
  • 15 Liu X, Wu Y, Chen Z, Ma M, Su L. A systematic review of randomized controlled trials on the therapeutic effect of intravenous sodium valproate in status epilepticus. Int J Neurosci 2012; 122 (06) 277-283
    CrossrefPubMedGoogle Scholar
  • 16 Trinka E, Höfler J, Zerbs A, Brigo F. Efficacy and safety of intravenous valproate for status epilepticus: a systematic review. CNS Drugs 2014; 28 (07) 623-639
    CrossrefPubMedGoogle Scholar
  • 17 Yasiry Z, Shorvon SD. The relative effectiveness of five antiepileptic drugs in treatment of benzodiazepine-resistant convulsive status epilepticus: a meta-analysis of published studies. Seizure 2014; 23 (03) 167-174
    CrossrefPubMedGoogle Scholar
  • 18 Misra UK, Kalita J, Maurya PK. Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled pilot study. J Neurol 2012; 259 (04) 645-648
    CrossrefPubMedGoogle Scholar
  • 19 Cock HR. ESETT Group. Established status epilepticus treatment trial (ESETT). Epilepsia 2011; 52 (Suppl. 08) 50-52
    PubMedGoogle Scholar
  • 20 Ben-Menachem E. Lacosamide: an investigational drug for adjunctive treatment of partial-onset seizures. Drugs Today (Barc) 2008; 44 (01) 35-40
    CrossrefPubMedGoogle Scholar
  • 21 Kellinghaus C, Berning S, Immisch I. et al. Intravenous lacosamide for treatment of status epilepticus. Acta Neurol Scand 2011; 123 (02) 137-141
    CrossrefPubMedGoogle Scholar
  • 22 Höfler J, Unterberger I, Dobesberger J, Kuchukhidze G, Walser G, Trinka E. Intravenous lacosamide in status epilepticus and seizure clusters. Epilepsia 2011; 52 (10) e148-e152
    CrossrefPubMedGoogle Scholar
  • 23 Krause LU, Brodowski KO, Kellinghaus C. Atrioventricular block following lacosamide intoxication. Epilepsy Behav 2011; 20 (04) 725-727
    CrossrefPubMedGoogle Scholar
  • 24 Reuber M, Evans J, Bamford JM. Topiramate in drug-resistant complex partial status epilepticus. Eur J Neurol 2002; 9 (01) 111-112
    CrossrefPubMedGoogle Scholar
  • 25 Bensalem MK, Fakhoury TA. Topiramate and status epilepticus: report of three cases. Epilepsy Behav 2003; 4 (06) 757-760
    CrossrefPubMedGoogle Scholar
  • 26 Hottinger A, Sutter R, Marsch S, Rüegg S. Topiramate as an adjunctive treatment in patients with refractory status epilepticus: an observational cohort study. CNS Drugs 2012; 26 (09) 761-772
    CrossrefPubMedGoogle Scholar
  • 27 Asadi-Pooya AA, Jahromi MJ, Izadi S, Emami Y. Treatment of refractory generalized convulsive status epilepticus with enteral topiramate in resource limited settings. Seizure 2015; 24: 114-117
    CrossrefPubMedGoogle Scholar
  • 28 Stojanova V, Rossetti AO. Oral topiramate as an add-on treatment for refractory status epilepticus. Acta Neurol Scand 2012; 125 (02) e7-e11
    CrossrefPubMedGoogle Scholar
  • 29 Block A, Fisher RS. Can patients perform volitional motor acts at the start of a seizure?. J Clin Neurophysiol 1999; 16 (02) 141-145
    CrossrefPubMedGoogle Scholar
  • 30 Kaibara M, Blume WT. The postictal electroencephalogram. Electroencephalogr Clin Neurophysiol 1988; 70 (02) 99-104
    CrossrefPubMedGoogle Scholar
  • 31 Naylor DE, Liu H, Wasterlain CG. Trafficking of GABA(A) receptors, loss of inhibition, and a mechanism for pharmacoresistance in status epilepticus. J Neurosci 2005; 25 (34) 7724-7733
    CrossrefPubMedGoogle Scholar
  • 32 Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 2002; 43 (02) 146-153
    PubMedGoogle Scholar
  • 33 DeLorenzo RJ, Waterhouse EJ, Towne AR. et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998; 39 (08) 833-840
    CrossrefPubMedGoogle Scholar
  • 34 Fernandez A, Lantigua H, Lesch C. et al. High-dose midazolam infusion for refractory status epilepticus. Neurology 2014; 82 (04) 359-365
    CrossrefPubMedGoogle Scholar
  • 35 Claassen J, Hirsch LJ, Emerson RG, Bates JE, Thompson TB, Mayer SA. Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology 2001; 57 (06) 1036-1042
    PubMedGoogle Scholar
  • 36 Stecker MM, Kramer TH, Raps EC, O’Meeghan R, Dulaney E, Skaar DJ. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia 1998; 39 (01) 18-26
    CrossrefPubMedGoogle Scholar
  • 37 Rossetti AO, Reichhart MD, Schaller MD, Despland PA, Bogousslavsky J. Propofol treatment of refractory status epilepticus: a study of 31 episodes. Epilepsia 2004; 45 (07) 757-763
    CrossrefPubMedGoogle Scholar
  • 38 Zhang Q, Yu Y, Lu Y, Yue H. Systematic review and meta-analysis of propofol versus barbiturates for controlling refractory status epilepticus. BMC Neurol 2019; 19 (01) 55
    CrossrefPubMedGoogle Scholar
  • 39 Zhan R-Z, Qi S, Wu C, Fujihara H, Taga K, Shimoji K. Intravenous anesthetics differentially reduce neurotransmission damage caused by oxygen-glucose deprivation in rat hippocampal slices in correlation with N-methyl-D-aspartate receptor inhibition. Crit Care Med 2001; 29 (04) 808-813
    CrossrefPubMedGoogle Scholar
  • 40 Sivakumar S, Ibrahim M, Parker Jr D, Norris G, Shah A, Mohamed W. Clobazam: an effective add-on therapy in refractory status epilepticus. Epilepsia 2015; 56 (06) e83-e89
    CrossrefPubMedGoogle Scholar
  • 41 Mahmoud SH, Rans C. Systematic review of clobazam use in patients with status epilepticus. Epilepsia Open 2018; 3 (03) 323-330
    CrossrefPubMedGoogle Scholar
  • 42 Kramer AH. Early ketamine to treat refractory status epilepticus. Neurocrit Care 2012; 16 (02) 299-305
    CrossrefPubMedGoogle Scholar
  • 43 Höfler J, Rohracher A, Kalss G. et al. (S)-ketamine in refractory and super-refractory status epilepticus: a retrospective study. CNS Drugs 2016; 30 (09) 869-876
    CrossrefPubMedGoogle Scholar
  • 44 Synowiec AS, Singh DS, Yenugadhati V, Valeriano JP, Schramke CJ, Kelly KM. Ketamine use in the treatment of refractory status epilepticus. Epilepsy Res 2013; 105 (01) (02) 183-188
    CrossrefPubMedGoogle Scholar
  • 45 Gaspard N, Foreman B, Judd LM. et al. Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study. Epilepsia 2013; 54 (08) 1498-1503
    CrossrefPubMedGoogle Scholar
  • 46 Kokate TG, Svensson BE, Rogawski MA. Anticonvulsant activity of neurosteroids: correlation with gamma-aminobutyric acid-evoked chloride current potentiation. J Pharmacol Exp Ther 1994; 270 (03) 1223-1229
    PubMedGoogle Scholar
  • 47 Rosenthal ES, Claassen J, Wainwright MS. et al. Brexanolone as adjunctive therapy in super-refractory status epilepticus. Ann Neurol 2017; 82 (03) 342-352
    CrossrefPubMedGoogle Scholar
  • 48 Rosenthal E, Wainwright MA. Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of SAGE-547 Injection in the Treatment of Subjects with Super-Refractory Status Epilepticus. 2019 Available at: https://clinicaltrials.gov/ct2/show/study/NCT02477618 Accessed September 4, 2019
    PubMedGoogle Scholar
  • 49 Zeiler FA, Matuszczak M, Teitelbaum J, Kazina CJ, Gillman LM. Intravenous immunoglobulins for refractory status epilepticus, part I: A scoping systematic review of the adult literature. Seizure 2017; 45: 172-180
    CrossrefPubMedGoogle Scholar
  • 50 Gasior M, Rogawski MA, Hartman AL. Neuroprotective and disease-modifying effects of the ketogenic diet. Behav Pharmacol 2006; 17 (05) (06) 431-439
    CrossrefPubMedGoogle Scholar
  • 51 Lin JJ, Lin KL, Chan OW, Hsia SH, Wang HS. CHEESE Study Group. Intravenous ketogenic diet therapy for treatment of the acute stage of super-refractory status epilepticus in a pediatric patient. Pediatr Neurol 2015; 52 (04) 442-445
    CrossrefPubMedGoogle Scholar
  • 52 Appavu B, Vanatta L, Condie J, Kerrigan JF, Jarrar R. Ketogenic diet treatment for pediatric super-refractory status epilepticus. Seizure 2016; 41: 62-65
    CrossrefPubMedGoogle Scholar
  • 53 Thakur KT, Probasco JC, Hocker SE. et al. Ketogenic diet for adults in super-refractory status epilepticus. Neurology 2014; 82 (08) 665-670
    CrossrefPubMedGoogle Scholar
  • 54 Cervenka MC, Hocker S, Koenig M. et al. Phase I/II multicenter ketogenic diet study for adult superrefractory status epilepticus. Neurology 2017; 88 (10) 938-943
    CrossrefPubMedGoogle Scholar
  • 55 Ikeda KM, Connors R, Lee DH, Khandji AG, Claassen J, Young GB. Isoflurane use in the treatment of super-refractory status epilepticus is associated with hippocampal changes on MRI. Neurocrit Care 2017; 26 (03) 420-427
    CrossrefPubMedGoogle Scholar
  • 56 Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 2004; 61 (08) 1254-1259
    PubMedGoogle Scholar
  • 57 Fugate JE, Burns JD, Wijdicks EFM, Warner DO, Jankowski CJ, Rabinstein AA. Prolonged high-dose isoflurane for refractory status epilepticus: is it safe?. Anesth Analg 2010; 111 (06) 1520-1524
    CrossrefPubMedGoogle Scholar
  • 58 Legriel S, Lemiale V, Schenck M. et al. HYBERNATUS Study Group. Hypothermia for neuroprotection in convulsive status epilepticus. N Engl J Med 2016; 375 (25) 2457-2467
    CrossrefPubMedGoogle Scholar
  • 59 Loddenkemper T, Cosmo G, Kotagal P. et al. Epilepsy surgery in children with electrical status epilepticus in sleep. Neurosurgery 2009; 64 (02) 328-337
    CrossrefPubMedGoogle Scholar
  • 60 Botre A, Udani V, Desai N, Jagadish S, Sankhe M. Emergency surgery for refractory status epilepticus. Indian Pediatr 2017; 54 (08) 678-680
    CrossrefPubMedGoogle Scholar
  • 61 Jeong A, Strahle J, Vellimana AK, Limbrick Jr DD, Smyth MD, Bertrand M. Hemispherotomy in children with electrical status epilepticus of sleep. J Neurosurg Pediatr 2017; 19 (01) 56-62
    CrossrefPubMedGoogle Scholar
  • 62 Zeiler FA, Zeiler KJ, Teitelbaum J, Gillman LM, West M. VNS for refractory status epilepticus. Epilepsy Res 2015; 112: 100-113
    CrossrefPubMedGoogle Scholar
  • 63 Novy J, Rossetti AO. Oral pregabalin as an add-on treatment for status epilepticus. Epilepsia 2010; 51 (10) 2207-2210
    CrossrefPubMedGoogle Scholar
  • 64 Dibué-Adjei M, Brigo F, Yamamoto T, Vonck K, Trinka E. Vagus nerve stimulation in refractory and super-refractory status epilepticus - a systematic review. Brain Stimul 2019; 12 (05) 1101-1110
    CrossrefPubMedGoogle Scholar
  • 65 Yildiz B, Citak A, Uçsel R, Karaböcüoğlu M, Aydinli N, Uzel N. Lidocaine treatment in pediatric convulsive status epilepticus. Pediatr Int 2008; 50 (01) 35-39
    CrossrefPubMedGoogle Scholar
  • 66 Arya R, Rotenberg A. Dietary, immunological, surgical, and other emerging treatments for pediatric refractory status epilepticus. Seizure 2019; 68: 89-96
    CrossrefPubMedGoogle Scholar
  • 67 Brigo F, Lattanzi S, Rohracher A. et al. Perampanel in the treatment of status epilepticus: a systematic review of the literature. Epilepsy Behav 2018; 86: 179-186
    CrossrefPubMedGoogle Scholar
  • 68 Ahmed J, Metrick M, Gilbert A. et al. Electroconvulsive therapy for super refractory status epilepticus. J ECT 2018; 34 (01) e5-e9
    CrossrefPubMedGoogle Scholar
  • 69 Claassen J, Perotte A, Albers D. et al. Nonconvulsive seizures after subarachnoid hemorrhage: multimodal detection and outcomes. Ann Neurol 2013; 74 (01) 53-64
    CrossrefPubMedGoogle Scholar
  • 70 Vespa PM, O’Phelan K, Shah M. et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology 2003; 60 (09) 1441-1446
    CrossrefPubMedGoogle Scholar
  • 71 Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 1996; 47 (01) 83-89
    CrossrefPubMedGoogle Scholar
  • 72 Litt B, Wityk RJ, Hertz SH. et al. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia 1998; 39 (11) 1194-1202
    CrossrefPubMedGoogle Scholar
  • 73 Shneker BF, Fountain NB. Assessment of acute morbidity and mortality in nonconvulsive status epilepticus. Neurology 2003; 61 (08) 1066-1073
    CrossrefPubMedGoogle Scholar
  • 74 Redecker J, Wittstock M, Benecke R, Rösche J. Efficacy of perampanel in refractory nonconvulsive status epilepticus and simple partial status epilepticus. Epilepsy Behav 2015; 45: 176-179
    CrossrefPubMedGoogle Scholar
  • 75 Laccheo I, Sonmezturk H, Bhatt AB. et al. Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients. Neurocrit Care 2015; 22 (02) 202-211
    CrossrefPubMedGoogle Scholar