Antiepileptic Drug Therapy for Status Epilepticus

Abstract

Status epilepticus (SE) is one of the most serious neurologic emergencies. SE is a condition that encompasses a broad range of semiologic subtypes and heterogeneous etiologies. The treatment of SE primarily involves the management of the underlying etiology and the use of antiepileptic drug therapy to rapidly terminate seizure activities. The Drug Committee of the Korean Epilepsy Society performed a review of existing guidelines and literature with the aim of providing practical recommendations for antiepileptic drug therapy. This article is one of a series of review articles by the Drug Committee and it summarizes staged antiepileptic drug therapy for SE. While evidence of good quality supports the use of benzodiazepines as the first-line treatment of SE, such evidence informing the administration of second- or third-line treatments is lacking; hence, the recommendations presented herein concerning the treatment of established and refractory SE are based on case series and expert opinions. The choice of antiepileptic drugs in each stage should consider the characteristics and circumstances of each patient, as well as their estimated benefit and risk to them. In tandem with the antiepileptic drug therapy, careful searching for and treatment of the underlying etiology are required.

PERMIT study: a global pooled analysis study of the effectiveness and tolerability of perampanel in routine clinical practice

“…Status epilepticus represents one of the most serious neurological emergencies [63] and encompasses a wide variety of subtypes and etiologies [64][65][66][67]. Benzodiazepines are typically used for first-line treatment of early status epilepticus, with intravenous ASMs administered as second-line therapy if seizures progress into established status epilepticus [66,[68][69][70].…”

“…Status epilepticus represents one of the most serious neurological emergencies [63] and encompasses a wide variety of subtypes and etiologies [64][65][66][67]. Benzodiazepines are typically used for first-line treatment of early status epilepticus, with intravenous ASMs administered as second-line therapy if seizures progress into established status epilepticus [66,[68][69][70]. ASMs commonly used in this setting include valproate, phenobarbital, phenytoin/fosphenytoin, levetiracetam and lacosamide, although there is no clear evidence for a preferred choice of second-line ASM therapy [66,68,69,71].…”

“…Benzodiazepines are typically used for first-line treatment of early status epilepticus, with intravenous ASMs administered as second-line therapy if seizures progress into established status epilepticus [66,[68][69][70]. ASMs commonly used in this setting include valproate, phenobarbital, phenytoin/fosphenytoin, levetiracetam and lacosamide, although there is no clear evidence for a preferred choice of second-line ASM therapy [66,68,69,71]. Evidence for the use of PER in the treatment of status epilepticus is currently limited.…”

A Comparison of Epileptogenic Effect of Status Epilepticus Treated With Diazepam, Midazolam, and Pentobarbital in the Mouse Pilocarpine Model of Epilepsy

“…The treatments against SE are firstly aimed to terminate seizures with antiepileptic drugs (AEDs) and then to prevent acute seizure recurrence. Diazepam, midazolam, lorazepam, phenobarbital, phenytoin, and valproate are some of the widely used AEDs for the treatment of SE ( 3 , 4 ). The treatment option is usually decided according to the stages and time points of SE.…”

“…The treatment option is usually decided according to the stages and time points of SE. For example, diazepam, lorazepam, pentobarbital, and midazolam are recommended as the first-line choices against early convulsive SE, while phenytoin and valproate are considered to be second-line choices against established convulsive SE ( 3 , 4 ). Among the numerous initial brain insults, symptomatic SE is one of the highest risk factors of epileptogenesis.…”