Skip to main content
SpringerLink
Log in

Status Epilepticus

  • Chapter
  • First Online:
Evidence-Based Critical Care

  • 319 Accesses

Abstract

Status epilepticus is a neurologic emergency that requires prompt recognition and intervention, with the primary goal of controlling electrographic and clinical seizures, to avoid neuronal injury. This chapter aims to guide the clinician in defining status epilepticus, ordering appropriate diagnostic tests, and administering proper therapeutic interventions. It also provides insight into management of special patient populations and novel therapies on the horizon.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Beran RG. An alternative perspective on the management of status epilepticus. Epilepsy Behav. 2008 Apr;12(3):349–53.

    PubMed  Google Scholar 

  2. Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5(3):246–56.

    PubMed  Google Scholar 

  3. Brophy G, Bell R, Claassen J, Alldredge B, Bleck T, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23.

    PubMed  Google Scholar 

  4. Meldrum BS, Horton RW. Physiology of status epilepticus in primates. Arch Neurol. 1973;28(1):1–9.

    CAS  PubMed  Google Scholar 

  5. Bleck TP. Refractory status epilepticus. Curr Opin Crit Care. 2005;11(2):117–20.

    PubMed  Google Scholar 

  6. 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):2802–18.

    PubMed  Google Scholar 

  7. Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, et al. New-onset refractory status epilepticus: etiology, clinical features, and outcome. Neurology. 2015;85(18):1604–13.

    PubMed  PubMed Central  Google Scholar 

  8. Goodkin HP, Yeh J, Kapur J. Status epilepticus increases the intracellular accumulation of GABAA receptors. J Neurosci. 2005;25(23):5511–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Goodkin HR, Joshi S, Kozhemyakin M, Kapur J. Impact of receptor changes on treatment of status epilepticus. Epilepsia. 2007;48(Suppl 8):14–5.

    PubMed  PubMed Central  Google Scholar 

  10. Naylor DE, Liu H, Wasterlain CG. Trafficking of GABA(A) receptors, loss of inhibition, and a mechanism for pharmacoresistance in status epilepticus. J Neurosci. 2005;25(34):7724–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Shearer P, Riviello J. Generalized convulsive status epilepticus in adults and children: treatment guidelines and protocols. Emerg Med Clin North Am. 2011;29(1):51–64.

    PubMed  Google Scholar 

  12. Lv R, Wang Q, Cui T, Zhu F, Shao X. Status epilepticus-related etiology, incidence and mortality: a meta-analysis. Epilepsy Res. 2017;136:12–7.

    PubMed  Google Scholar 

  13. Marawar R, Basha M, Mahulikar A, Desai A, Suchdev K, Shah A. Updates in refractory status epilepticus. Crit Care Res Pract. 2018;2018:9768949.

    PubMed  PubMed Central  Google Scholar 

  14. Alroughani R, Javidan M, Qasem A, Alotaibi N. Non-convulsive status epilepticus; the rate of occurrence in a general hospital. Seizure. 2009;18(1):38–42.

    CAS  PubMed  Google Scholar 

  15. Veran O, Kahane P, Thomas P, Hamelin S, Sabourdy C, Vercueil L. De novo epileptic confusion in the elderly: a 1-year prospective study. Epilepsia. 2010;51(6):1030–5.

    PubMed  Google Scholar 

  16. Gungor Tuncer O, Altindag E, Ozel Yildiz S, Nalbantoglu M, Acik ME, Tavukcu Ozkan S, et al. Reevaluation of the critically ill patients with nonconvulsive status epilepticus by using Salzburg consensus criteria. Clin EEG Neurosci. 2018;49(6):425–32.

    PubMed  Google Scholar 

  17. Rossetti AO, Logroscino G, Liaudet L, Ruffieux C, Ribordy V, Schaller MD, et al. Status epilepticus: an independent outcome predictor after cerebral anoxia. Neurology. 2007;69(3):255–60.

    CAS  PubMed  Google Scholar 

  18. Rossetti AO, Milligan TA, Vulliémoz S, Michaelides C, Bertschi M, Lee JW. A randomized trial for the treatment of refractory status epilepticus. Neurocrit Care. 2011;14(1):4–10.

    CAS  PubMed  Google Scholar 

  19. Kantanen A, Reinikainen M, Parviainen I, Kälviäinen R. Long-term outcome of refractory status epilepticus in adults: a retrospective population-based study. Epilepsy Res. 2017;133:13–21.

    PubMed  Google Scholar 

  20. Hocker SE, Britton JW, Mandrekar JN, Wijdicks EFM, Rabinstein AA. Predictors of outcome in refractory status epilepticus. JAMA Neurol. 2013;70(1):72–7.

    PubMed  Google Scholar 

  21. Hocker SE. Status epilepticus. CONTINUUM Lifelong Learn Neurol. 2015;21(5):1362.

    Google Scholar 

  22. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, 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(1):48–61.

    PubMed  PubMed Central  Google Scholar 

  23. Leppik IE, Derivan AT, Homan RW, Walker J, Ramsay RE, Patrick B. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA. 1983;249(11):1452–4.

    CAS  PubMed  Google Scholar 

  24. Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345(9):631–7.

    CAS  PubMed  Google Scholar 

  25. Welch RD, Nicholas K, Durkalski-Mauldin VL, Lowenstein DH, Conwit R, Mahajan PV, et al. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia. 2015;56(2):254–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Appleton R, Sweeney A, Choonara I, Robson J, Molyneux E. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Dev Med Child Neurol. 1995;37(8):682–8.

    CAS  PubMed  Google Scholar 

  27. DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46(4):1029–35.

    CAS  PubMed  Google Scholar 

  28. Agarwal P, Kumar N, Chandra R, Gupta G, Antony AR, Garg N. Randomized study of intravenous valproate and phenytoin in status epilepticus. Seizure. 2007;16(6):527–32.

    PubMed  Google Scholar 

  29. Misra UK, Kalita J, Patel R. Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology. 2006;67(2):340–2.

    CAS  PubMed  Google Scholar 

  30. Chakravarthi S, Goyal MK, Modi M, Bhalla A, Singh P. Levetiracetam versus phenytoin in management of status epilepticus. J Clin Neurosci. 2015;22(6):959–63.

    CAS  PubMed  Google Scholar 

  31. Navarro V, Dagron C, Elie C, Lamhaut L, Demeret S, Urien S, et al. Prehospital treatment with levetiracetam plus clonazepam or placebo plus clonazepam in status epilepticus (SAMUKeppra): a randomised, double-blind, phase 3 trial. Lancet Neurol. 2016;15(1):47–55.

    CAS  PubMed  Google Scholar 

  32. Rossetti AO. Which anesthetic should be used in the treatment of refractory status epilepticus? Epilepsia. 2007;48(Suppl 8):52–5.

    PubMed  Google Scholar 

  33. Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011;10(10):922–30.

    PubMed  PubMed Central  Google Scholar 

  34. Prasad A, Worrall BB, Bertram EH, Bleck TP. Propofol and midazolam in the treatment of refractory status epilepticus. Epilepsia. 2001;42(3):380–6.

    CAS  PubMed  Google Scholar 

  35. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43(2):146–53.

    CAS  PubMed  Google Scholar 

  36. Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40(6):759–62.

    CAS  PubMed  Google Scholar 

  37. Lee WK, Liu KT, Young BWY. Very-high-dose phenobarbital for childhood refractory status epilepticus. Pediatr Neurol. 2006;34(1):63–5.

    PubMed  Google Scholar 

  38. Fountain NB. Status epilepticus: risk factors and complications. Epilepsia. 2000;41(Suppl 2):23.

    Google Scholar 

  39. Hyzy RC. Evidence-based critical care: a case study approach. Cham: Springer; 2017.

    Google Scholar 

  40. Legriel S, Lemiale V, Schenck M, Chelly J, Laurent V, Daviaud F, et al. Hypothermia for neuroprotection in convulsive status epilepticus. N Engl J Med. 2016;375(25):2457–67.

    PubMed  Google Scholar 

  41. Höfler J, Trinka E. Intravenous ketamine in status epilepticus. Epilepsia. 2018;59:198–206.

    PubMed  Google Scholar 

  42. Seder DB, Sunde K, Rubertsson S, Mooney M, Stammet P, Riker RR, et al. Neurologic outcomes and postresuscitation care of patients with myoclonus following cardiac arrest. Crit Care Med. 2015;43(5):965–72.

    PubMed  Google Scholar 

  43. Mikhaeil-Demo Y, Gavvala JR, Bellinski II, Macken MP, Narechania A, Templer JW, et al. Clinical classification of post anoxic myoclonic status. Resuscitation. 2017;119:76–80.

    PubMed  Google Scholar 

  44. Stecker MM, Cheung AT, Pochettino A, Kent GP, Patterson T, Weiss SJ, et al. Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg. 2001;71(1):14–21.

    CAS  PubMed  Google Scholar 

  45. Rossetti AO, Oddo M, Liaudet L, Kaplan PW. Predictors of awakening from postanoxic status epilepticus after therapeutic hypothermia. Neurology. 2009;72(8):744–9.

    PubMed  Google Scholar 

  46. Rajiv KR, Radhakrishnan A. Status epilepticus in pregnancy: etiology, management, and clinical outcomes. Epilepsy Behav. 2017;11(76):114–9.

    Google Scholar 

  47. Harden CL, Hopp J, Ting TY, Pennell PB, French JA, Hauser WA, et al. Practice parameter update: management issues for women with epilepsy—focus on pregnancy (an evidence-based review): obstetrical complications and change in seizure frequency: report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73(2):126–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Harutyunyan G, Hauer L, Dünser MW, Karamyan A, Moser T, Pikija S, et al. Autoimmune encephalitis at the neurological intensive care unit: etiologies, reasons for admission and survival. Neurocrit Care. 2017;27(1):82–9.

    CAS  PubMed  Google Scholar 

  49. Holzer FJ, Seeck M, Korff CM. Autoimmunity and inflammation in status epilepticus: from concepts to therapies. Expert Rev Neurother. 2014;14(10):1181–202.

    CAS  PubMed  Google Scholar 

  50. Spatola M, Novy J, Du Pasquier R, Dalmau J, Rossetti AO. Status epilepticus of inflammatory etiology: a cohort study. Neurology. 2015;85(5):464–70.

    PubMed  PubMed Central  Google Scholar 

  51. Kirmani BF, Barr D, Robinson DM, Pranske Z, Fonkem E, Benge J, et al. Management of autoimmune status epilepticus. Front Neurol. 2018;9:259.

    PubMed  PubMed Central  Google Scholar 

  52. Zeiler FA, Matuszczak M, Teitelbaum J, Kazina CJ, Gillman LM. Plasmapheresis for refractory status epilepticus, Part I: A scoping systematic review of the adult literature. Seizure. 2016;43:14–22.

    CAS  PubMed  Google Scholar 

  53. Toledano M, Britton JW, McKeon A, Shin C, Lennon VA, Quek AML, et al. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology. 2014;82(18):1578–86.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA

    Hannah Breit

  2. Department of Neurological Sciences, Neurocritical Care, Rush University Medical Center, Chicago, IL, USA

    Lauren Koffman

Authors
  1. Hannah Breit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren Koffman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hannah Breit .

Editor information

Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C. Hyzy

  2. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Jakob McSparron

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Breit, H., Koffman, L. (2020). Status Epilepticus. In: Hyzy, R.C., McSparron, J. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-26710-0_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26710-0_40

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26709-4

  • Online ISBN: 978-3-030-26710-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation