Guidelines for the Evaluation and Management of Status Epilepticus

Abstract

Status epilepticus (SE) treatment strategies vary substantially from one institution to another due to the lack of data to support one treatment over another. To provide guidance for the acute treatment of SE in critically ill patients, the Neurocritical Care Society organized a writing committee to evaluate the literature and develop an evidence-based and expert consensus practice guideline. Literature searches were conducted using PubMed and studies meeting the criteria established by the writing committee were evaluated. Recommendations were developed based on the literature using standardized assessment methods from the American Heart Association and Grading of Recommendations Assessment, Development, and Evaluation systems, as well as expert opinion when sufficient data were lacking.

Long‐term outcomes of status epilepticus: A critical assessment

“…Treatment of SE mostly follows general treatment guidelines and algorithms 1, 2. The first line usually consists of benzodiazepines, often followed by intravenous nonbenzodiazepine antiseizure medications (ASMs).…”

“…The first line usually consists of benzodiazepines, often followed by intravenous nonbenzodiazepine antiseizure medications (ASMs). If SE continues and becomes refractory, guidelines recommend transfer to the intensive care unit and additional anesthetic treatment, ideally within 30 or 40 minutes after SE onset 1, 2, 25. The most common drugs at this treatment stage are continuous infusions of midazolam, infusions of pentobarbital/thiopental, or intermittent phenobarbital doses 1.…”

“…If SE continues and becomes refractory, guidelines recommend transfer to the intensive care unit and additional anesthetic treatment, ideally within 30 or 40 minutes after SE onset 1, 2, 25. The most common drugs at this treatment stage are continuous infusions of midazolam, infusions of pentobarbital/thiopental, or intermittent phenobarbital doses 1. Main adverse events may include respiratory depression and hypotension, and thus mechanical ventilation and blood pressure management are often needed 25.…”

“…Status epilepticus (SE), especially refractory SE (RSE), is a life‐threatening condition often requiring intensive care 1, 2, 3, 4. Long‐term sequelae may include neurological, cognitive, and behavioral impairments and decline in quality of life (QoL),4, 5 and impose heavy burdens on the patient, the caregivers, and the healthcare system.…”

Brexanolone as adjunctive therapy in super‐refractory status epilepticus

“…A major concern for current treatments is the lack of clinical evidence for treatment outcomes 5, 6. Between 26.6% and 36.6% of patients with SE fail to respond to the administration of first‐line agents,7, 8 of which approximately 23% also fail second‐line agents9 and 10% to 15% fail TLAs,10 thus progressing to SRSE.…”