Evidence-based guideline on management of status epilepticus in adult intensive care unit in resource-limited settings: a review article

Abstract

Background: Status epilepticus (SE) is a life-threatening condition associated with at least 5 min of continuous seizures or repeated seizures without regaining consciousness between episodes. It is a medical emergency with significant morbidity and mortality. The most common causes of SE are previous seizures, stroke, trauma, metabolic disorders, and central nervous system tumor. The aim of this review was to systematically review articles and ultimately develop evidence-based guidelines for the management of SE in resource-limited settings. Methods: This review was presented under the Protocol for Systematic Reviews and Meta-Analyses (PRISMA). A literature search was performed in PubMed, Google Scholar, Cochrane, and Medline databases from 2007 to 2021. The keywords for the literature search were (SE or controlled clinical trial) AND (SE or randomized controlled trial), (SE or multicenter trial) AND (SE or meta-analysis) AND (SE or crossover study). Conclusion: SE is an urgent medical emergency that requires early recognition and aggressive treatment. Medical treatment is initiated when seizures continue for more than 5 min after all stabilization measures have been taken. Based on the available evidence, diazepam can be used as a substitute for lorazepam in the treatment of SE. Ketamine is effective when given before other anesthetics as a third-line treatment in refractory and very refractory epilepsy. Propofol reduced the number of days of mechanical ventilation in the treatment of SE and has better seizure control than thiopental. Music has been recommended as an adjunctive therapy for epilepsy medication.

Ketamine: Pro or antiepileptic agent? A systematic review

“…Despite the lack of robust randomized trials, ketamine is generally preferred as a third-line medication for RSE and SRSE. In a recent guideline for the management of status epilepticus, Besha et., al listed ketamine as class 2a, which denotes the availability of systematic reviews [ 52 ]. In addition, a survey for Canadian physicians showed that 47.4 % of physicians working with patients with SE used ketamine for the treatment of RSE [ 53 ].…”