Status Epilepticus: Work-Up and Management in Adults

Assia Meziane-Tani; Brandon Foreman; Moshe A. Mizrahi

doi:10.1055/s-0040-1719112

Seminars in Neurology, Table of Contents

Semin Neurol 2020; 40(06): 652-660
DOI: 10.1055/s-0040-1719112

Review Article

Status Epilepticus: Work-Up and Management in Adults

Authors

Assia Meziane-Tani

¹Division of Neurocritical Care, Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
Brandon Foreman

¹Division of Neurocritical Care, Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
Moshe A. Mizrahi

¹Division of Neurocritical Care, Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio

Abstract

Status epilepticus is one of the most common neurological emergencies and is likely to have increasing prevalence in coming years given an aging “baby boomer” population in the United States. Because status epilepticus is associated with significant morbidity and mortality, identification and treatment are paramount. Care should be taken to exclude nonorganic mimics and infectious and metabolic causes. Status epilepticus can be classified into stages with associated recommendations for escalation in therapy, increasing from push-dose benzodiazepines to continuous anesthetic infusions and other nontraditional therapies. Concurrent electroencephalogram monitoring helps to identify, localize, and assess resolution of ictal patterns alongside antiseizure drug administration. A protocol is proposed for the management of status epilepticus in a step-wise fashion.

Keywords

status epilepticus - work-up - management - adults

Full Text

References

References
1 Waterhouse E. Status epilepticus. Continuum (Minneap Minn) 2010; 16 (3 Epilepsy): 199-227
2 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
3 Sánchez S, Rincon F. Status epilepticus: epidemiology and public health needs. J Clin Med 2016; 5 (08) 71
4 Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol 2006; 5 (03) 246-256
5 Husain AM, Sinha SR. Continuous EEG Monitoring Principles and Practice. Cham: Springer International Publishing; 2017
6 Dhakar MB, Hirsch LJ. Continuous EEG monitoring for status epilepticus. In: Drislane F, Kaplan PW. eds. Current Clinical Neurology: Status Epilepticus. 2nd ed. Cham: Springer; 2018: 283-298
7 Jirsch J, Hirsch LJ. Nonconvulsive seizures: developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol 2007; 118 (08) 1660-1670
8 Grönheit W, Popkirov S, Wehner T, Schlegel U, Wellmer J. Practical management of epileptic seizures and status epilepticus in adult palliative care patients. Front Neurol 2018; 9: 595
9 Kinney MO, Craig JJ, Kaplan PW. Non-convulsive status epilepticus: mimics and chameleons. Pract Neurol 2018; 18 (04) 291-305
10 Huff JS, Murr N. Pseudoseizures. [Updated Feb 28, 2019]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. 2019. Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK441871/. Accessed May 25, 2019
11 Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain 2011; 134 (Pt 10): 2802-2818
12 Rai S, Drislane FW. Treatment of refractory and super-refractory status epilepticus. Neurotherapeutics 2018; 15 (03) 697-712
13 Vasan S, Kumar A. Wernicke encephalopathy. [Updated November 14, 2018]. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. 2019. Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470344/. Accessed May 27, 2019
14 Brophy GM, Bell R, Claassen J. Neurocritical Care Society Status Epilepticus Guideline Writing Committee. et al; Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 2012; 17 (01) 3-23
15 Trinka E, Leitinger M. Which EEG patterns in coma are nonconvulsive status epilepticus?. Epilepsy Behav 2015; 49: 203-222
16 Beniczky S, Hirsch LJ, Kaplan PW. et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus. Epilepsia 2013; 54 (Suppl. 06) 28-29
17 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
18 Silbergleit R, Lowenstein D, Durkalski V, Conwit R. Neurological Emergency Treatment Trials (NETT) Investigators. RAMPART (Rapid Anticonvulsant Medication Prior to Arrival Trial): a double-blind randomized clinical trial of the efficacy of intramuscular midazolam versus intravenous lorazepam in the prehospital treatment of status epilepticus by paramedics. Epilepsia 2011; 52 (Suppl. 08) 45-47
19 Silbergleit R, Lowenstein D, Durkalski V, Conwit R. NETT Investigators. Lessons from the RAMPART study–and which is the best route of administration of benzodiazepines in status epilepticus. Epilepsia 2013; 54 (Suppl. 06) 74-77
20 Silbergleit R, Durkalski V, Lowenstein D. NETT Investigators. et al; Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012; 366 (07) 591-600
21 Lacy CF, Armstrong LL, Goldman MP, Lance LL. Drug Information Handbook. 20th ed. Hudson, OH: Lexi-Comp; 2011
22 Trinka E, Höfler J, Leitinger M, Brigo F. Pharmacotherapy for status epilepticus. Drugs 2015; 75 (13) 1499-1521
23 Treiman DM, Meyers PD, Walton NY. Veterans Affairs Status Epilepticus Cooperative Study Group. et al; A comparison of four treatments for generalized convulsive status epilepticus. N Engl J Med 1998; 339 (12) 792-798
24 Litt B, Wityk RJ, Hertz SH. et al. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia 1998; 39 (11) 1194-1202
25 Garbovsky LA, Drumheller BC, Perrone J. Purple glove syndrome after phenytoin or fosphenytoin administration: review of reported cases and recommendations for prevention. J Med Toxicol 2015; 11 (04) 445-459
26 Cherian A, Thomas SV. Status epilepticus. Ann Indian Acad Neurol 2009; 12 (03) 140-153
27 Abou-Khalil BW. Update on antiepileptic drugs 2019. Continuum (Minneap Minn) 2019; 25 (02) 508-536
28 Glauser T, Shinnar S, Gloss D. et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016; 16 (01) 48-61
29 Valproic Acid, Drug Information, UptoDate. 2019 . Available at: https://www.uptodate.com/contents/valproate-drug-information?search=valproicacid&source=panel_search_result&selectedTitle=1∼148&usage_type=panel&kp_tab=drug_general&display_rank=1. Accessed June 5, 2019
30 O'Connor J, Levy P, Wilson SS. Levetiracetam is as effective as phenytoin for status epilepticus with less adverse events in the ED. Crit Care Med 2015; 43 (12) 6
31 Abou-Khalil B. Levetiracetam in the treatment of epilepsy. Neuropsychiatr Dis Treat 2008; 4 (03) 507-523
32 Strzelczyk A, Zöllner JP, Willems LM. et al. Lacosamide in status epilepticus: systematic review of current evidence. Epilepsia 2017; 58 (06) 933-950
33 Husain AM. Lacosamide in status epilepticus: update on the TRENdS study. Epilepsy Behav 2015; 49: 337-339
34 Phenobarbital: Drug information, UptoDate. 1996 . Available at: https://www.uptodate.com/contents/phenobarbital-drug-information?search=phenobarbital&source=panel_search_result&selectedTitle=1∼148&usage_type=panel&kp_tab=drug_general&display_rank=1. Accessed June 5, 2019
35 Kapur J, Elm J, Chamberlain JM. NETT and PECARN Investigators. et al; Randomized trial of three anticonvulsant medications for status epilepticus. N Engl J Med 2019; 381 (22) 2103-2113
36 Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol 2011; 10 (10) 922-930
37 Sahinovic MM, Struys MMRF, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet 2018; 57 (12) 1539-1558
38 Kam PC, Cardone D. Propofol infusion syndrome. Anaesthesia 2007; 62 (07) 690-701
39 Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: a pathophysiologic approach. New York, NY: Mcgraw-Hill; 2011
40 Pugin D, Foreman B, De Marchis GM. et al. Is pentobarbital safe and efficacious in the treatment of super-refractory status epilepticus: a cohort study. Crit Care 2014; 18 (03) R103
41 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
42 Martin BS, Kapur J. A combination of ketamine and diazepam synergistically controls refractory status epilepticus induced by cholinergic stimulation. Epilepsia 2008; 49 (02) 248-255
43 Niquet J, Baldwin R, Norman K, Suchomelova L, Lumley L, Wasterlain CG. Midazolam-ketamine dual therapy stops cholinergic status epilepticus and reduces Morris water maze deficits. Epilepsia 2016; 57 (09) 1406-1415
44 Sabharwal V, Ramsay E, Martinez R. et al. Propofol-ketamine combination therapy for effective control of super-refractory status epilepticus. Epilepsy Behav 2015; 52 (Pt A): 264-266
45 Zaccara G, Giannasi G, Oggioni R, Rosati E, Tramacere L, Palumbo P. convulsive status epilepticus study group of the uslcentro Toscana, Italy. Challenges in the treatment of convulsive status epilepticus. Seizure 2017; 47: 17-24
46 Kim DH, Kang HH, Kim M. et al. Successful use of therapeutic hypothermia for refractory nonconvulsive status epilepticus. J Epilepsy Res 2017; 7 (02) 109-114
47 Legriel S, Pico F, Tran-Dinh YR. et al. Neuroprotective effect of therapeutic hypothermia versus standard care alone after convulsive status epilepticus: protocol of the multicentre randomised controlled trial HYBERNATUS. Ann Intensive Care 2016; 6 (01) 54
48 Lancaster E. The diagnosis and treatment of autoimmune encephalitis. J Clin Neurol 2016; 12 (01) 1-13