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Managing Critically III Patients with Status Epilepticus

  • Conference paper
Intensive Care Medicine

Abstract

Status epilepticus is a major medical emergency that is fatal in 7.6–22% of cases [1, 2]. The incidence per 100,000 population has been estimated at 9.9 episodes in Europe and 41 episodes in the USA [2]. Status epilepticus is a clinical and electrical entity in which the broad spectrum of clinical presentations may lead to over-or underdiagnosis. Status epilepticus may be convulsive, i.e., accompanied by motor activity, or nonconvulsive. Continuous or repeated electrical seizures without recovery of consciousness characterizes both forms of status epilepticus. Morbidity and mortality rates differ between convulsive and nonconvulsive status epilepticus, and each requires a specific treatment strategy. Knowledge of the current definition and electroclinical classification of status epilepticus, as well as familiarity with differential diagnoses, is essential to ensure appropriate treatment.

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References

  1. Meierkord H, Boon P, Engelsen B, et al (2006) EFNS guideline on the management of status epilepticus. Eur J Neurol 13:445–450

    Article  PubMed  CAS  Google Scholar 

  2. Chin RF, Neville BG, Scott RC (2004) A systematic review of the epidemiology of status epilepticus. Eur J Neurol 11:800–810

    Article  PubMed  CAS  Google Scholar 

  3. Lowenstein DH, Bleck T, Macdonald RL (1999) It’s time to revise the definition of status epilepticus. Epilepsia 40:120–122

    Article  PubMed  CAS  Google Scholar 

  4. Chen JW, Wasterlain CG (2006) Status epilepticus: pathophysiology and management in adults. Lancet Neurol 5:246–256

    Article  PubMed  Google Scholar 

  5. Jenssen S, Gracely EJ, Sperling MR (2006) How long do most seizures last? A systematic comparison of seizures recorded in the Epilepsy Monitoring Unit. Epilepsia 47:1499–1503

    Article  PubMed  Google Scholar 

  6. DeLorenzo RJ, Garnett LK, Towne AR, et al (1999) Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Epilepsia 40:164–169

    Article  PubMed  CAS  Google Scholar 

  7. Eriksson K, Metsaranta P, Huhtala H, Auvinen A, Kuusela AL, Koivikko M (2005) Treatment delay and the risk of prolonged status epilepticus. Neurology 65:1316–1318

    Article  PubMed  CAS  Google Scholar 

  8. Walker M, Cross H, Smith S, et al (2005) Non convulsive status epilepticus: Epilepsy Research Foundation Workshop Reports. Epileptic Disord 7:253–296

    PubMed  Google Scholar 

  9. Jirsch J, Hirsch LJ (2007) Nonconvulsive seizures: Developing a rational approach to the diagnosis and management in the critically ill population. Clin Neurophysiol 118:1660–1670

    Article  PubMed  CAS  Google Scholar 

  10. Coeytaux A, Jallon P (2000) The difficulty of defining and classifying status epilepticus. Neurophysiol Clin 30:133–138

    Article  PubMed  CAS  Google Scholar 

  11. Walker M (2005) Status epilepticus: an evidence based guide. BMJ 331:673–677

    Article  PubMed  Google Scholar 

  12. Assal F, Coeytaux A, Jallon P (2000) Drug resistant status epilepticus. Neurophysiol Clin 30: 139–145

    Article  PubMed  CAS  Google Scholar 

  13. Reuber M, Pukrop R, Mitchell AJ, Bauer J, Elger CE (2003) Clinical significance of recurrent psychogenic nonepileptic seizure status. J Neurol 250:1355–1362

    Article  PubMed  Google Scholar 

  14. Walker MC, Howard RS, Smith SJ, Miller DH, Shorvon SD, Hirsch NP (1996) Diagnosis and treatment of status epilepticus on a neurological intensive care unit. QJM 89:913–920

    PubMed  CAS  Google Scholar 

  15. Holtkamp M, Othman J, Buchheim K, Meierkord H (2006) Diagnosis of psychogenic nonepileptic status epilepticus in the emergency setting. Neurology 66:1727–1729

    Article  PubMed  Google Scholar 

  16. Chung SS, Gerber P, Kirlin KA (2006) Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology 66:1730–1731

    Article  PubMed  Google Scholar 

  17. Chen DK, So YT, Fisher RS; Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology (2005) Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 65:668–675

    Google Scholar 

  18. Dworetzky BA, Mortati KA, Rossetti AO, Vaccaro B, Nelson A, Bromfield EB (2006) Clinical characteristics of psychogenic nonepileptic seizure status in the long-term monitoring unit. Epilepsy Behav 9:335–338

    Article  PubMed  Google Scholar 

  19. Thomke F, Marx JJ, Sauer O, et al (2005) Observations on comatose survivors of cardiopulmonary resuscitation with generalized myoclonus. BMC Neurol 18:1–14

    Google Scholar 

  20. Wijdicks EF, Hijdra A, Young GB, et al (2006) Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 67:203–210

    Article  PubMed  CAS  Google Scholar 

  21. Riggio S (2005) Nonconvulsive status epilepticus: clinical features and diagnostic challenges. Psychiatr Clin North Am 28:653–664

    Article  PubMed  Google Scholar 

  22. Meierkord H, Holtkamp M (2007) Non-convulsive status epilepticus in adults: clinical forms and treatment. Lancet Neurol 6:329–339

    Article  PubMed  Google Scholar 

  23. Young GB, Campbell VC (1999) EEG monitoring in the intensive care unit: pitfalls and caveats. J Clin Neurophysiol 16:40–45

    Article  PubMed  CAS  Google Scholar 

  24. Brenner RP (2002) Is it status? Epilepsia 43:103–113

    Article  PubMed  Google Scholar 

  25. Treiman DM, Meyers PD, Walton NY, et al (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339:792–798

    Article  PubMed  CAS  Google Scholar 

  26. Prasad A, Al-Roomi K, Krishnan PR, Sequeira R (2005) Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev CD003723

    Google Scholar 

  27. Limdi NA, Shimpi AV, Faught E, Gomez CR, Burneo JG (2005) Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology 64:353–355

    PubMed  CAS  Google Scholar 

  28. Venkataraman V, Wheless JW (1999) Safety of rapid intravenous infusion of valproate loading doses in epilepsy patients. Epilepsy Res 35:147–153

    Article  PubMed  CAS  Google Scholar 

  29. Misra UK, Kalita J, Patel R (2006) Sodium valproate vs phenytoin in status epilepticus: A pilot study. Neurology 67:340–342

    Article  PubMed  CAS  Google Scholar 

  30. Van rijckevorsel K, Boon P, Hauman H, et al (2005) Standards of care for adults with convulsive status epilepticus: Belgian consensus recommendations. Acta Neurol Belg 105:111–118

    Google Scholar 

  31. Lowenstein DH (2006) The management of refractory status epilepticus: an update. Epilepsia 47:35–40

    Article  PubMed  Google Scholar 

  32. Lowenstein DH (2005) Treatment options for status epilepticus. Curr Opin Pharmacol 5: 334–339

    Article  PubMed  Google Scholar 

  33. Claassen J, Hirsch LJ, Emerson RG, Mayer SA (2002) Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 43:146–153

    Article  PubMed  CAS  Google Scholar 

  34. Parviainen I, Uusaro A, Kälviäinen R, Kaukanen E, Mervaala E, Ruokonen E (2002) Highdose thiopental in the treatment of refractory status epilepticus in intensive care unit. Neurology 59:1249–1251

    Article  PubMed  CAS  Google Scholar 

  35. Parviainen I, Uusaro A, Kalviainen R, Mervaala E, Ruokonen E (2006) Propofol in the treatment of refractory status epilepticus. Intensive Care Med 32:1075–1079

    Article  PubMed  CAS  Google Scholar 

  36. Dhar R, Mirsattari SM (2006) Current approach to the diagnosis and treatment of refractory status epilepticus. Adv Neurol 97:245–254

    PubMed  Google Scholar 

  37. Holtkamp M (2007) The anaesthetic and intensive care of status epilepticus. Curr Opin Neurol 20:188–193

    Article  PubMed  CAS  Google Scholar 

  38. Bialer M, Johannessen SI, Kupferberg HJ, Levy RH, Perucca E, Tomson T (2007) Progress report on new antiepileptic drugs: a summary of the Eigth Eilat Conference (EILAT VIII). Epilepsy Res 73:1–52

    Article  PubMed  Google Scholar 

  39. Patel NC, Landan IR, Levin J, Szaflarski J, Wilner AN (2006) The use of levetiracetam in refractory status epilepticus. Seizure 15:137–141

    Article  PubMed  Google Scholar 

  40. Rupprecht S, Franke K, Fitzek S, Witte OW, Hagemann G (2007) Levetiracetam as a treatment option in non-convulsive status epilepticus. Epilepsy Res 73:238–244

    Article  PubMed  CAS  Google Scholar 

  41. Reuber M, Evans J, Bamford JM (2002) Topiramate in drug-resistant complex partial status epilepticus. Eur J Neurol 9:111–112

    Article  PubMed  CAS  Google Scholar 

  42. Schmitt FC, Buchheim K, Meierkord H, Holtkamp M (2006) Anticonvulsant properties of hypothermia in experimental status epilepticus. Neurobiol Dis 23:689–696

    Article  PubMed  CAS  Google Scholar 

  43. Orlowski JP, Erenberg G, Lueders H, Cruse RP (1984) Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med 12:367–372

    Article  PubMed  CAS  Google Scholar 

  44. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF (2002) Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 59:205–210

    Article  PubMed  Google Scholar 

  45. Thomas P (2000) Status epilepticus with confusional symptomatology. Neurophysiol Clin 30:147–154

    Article  PubMed  CAS  Google Scholar 

  46. DeLorenzo RJ, Waterhouse EJ, Towne AR, et al (1998) Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 39:833–840

    Article  PubMed  CAS  Google Scholar 

  47. Thomas P (1997) Status epilepticus: indications for emergency EEG. Neurophysiol Clin 27:398–405

    Article  PubMed  CAS  Google Scholar 

  48. Rossetti AO, Logroscino G, Bromfield EB (2005) Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol 62:1698–1703

    Article  PubMed  Google Scholar 

  49. Young GB (2006) Nonconvulsive seizures and electroencephalogram monitoring in the intensive care unit. Adv Neurol 97:221–227

    PubMed  Google Scholar 

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Legriel, S., Bedos, J.P., Azoulay, E. (2008). Managing Critically III Patients with Status Epilepticus. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-77383-4_76

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  • DOI: https://doi.org/10.1007/978-0-387-77383-4_76

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-77382-7

  • Online ISBN: 978-0-387-77383-4

  • eBook Packages: MedicineMedicine (R0)

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