Status Epilepticus

  • Andreas H. Kramer
  • Thomas P. Bleck
  • Thomas P. Bleck


Prolonged or recurrent seizures can cause life-threatening systemic and neurological complications. Status epilepticus (SE) has traditionally been defined as more than 30 min of either continuous seizure activity or a series of seizures during which there is incomplete recovery of consciousness. There are several reasons why a shorter duration might be more appropriate for an operational definition of SE. First, the duration of a generalized seizure rarely exceeds 2 min, and spontaneous resolution becomes unlikely after 5–10 min. Second, seizures become more difficult to abort pharmacologically over time. Third, systemic complications frequently occur even after a few minutes. Finally, the duration of time leading to neuronal injury is uncertain, and could conceivably be less than 30 min in certain cases. Longer seizure duration has been associated with worse outcomes. It would be inappropriate and harmful to delay pharmacologic treatment of seizures for 30 min. Consequently, recent large clinical trials assessing management of SE have employed durations of only 5–10 min in their inclusion criteria. Another approach that has been advocated to remain consistent with the previous definition is to define seizures lasting 10–29 min as “impending SE.”


Status Epilepticus West Nile Virus Neurocritical Care Refractory Status Epilepticus Electrographic Seizure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus. JAMA 1993;270:854–859.Google Scholar
  2. 2.
    Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40:120–122.PubMedGoogle Scholar
  3. 3.
    Theodore WH, Porter RJ, Albert P, et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology. 1994;44:1403–1407.PubMedGoogle Scholar
  4. 4.
    Kramer R, Levisohn P. The duration of secondarily generalized tonic-clonic seizures. Epilepsia. 1992;33(suppl 3):68.Google Scholar
  5. 5.
    Shinnar S, Berg AT, Moshe SL, et al. How long do new-onset seizures in children last? Ann Neurol. 2001;49:659–664.PubMedGoogle Scholar
  6. 6.
    Eriksson K, Metsaranta P, Huhtala H, et al. Treatment delay and the risk of prolonged status epilepticus. Neurology. 2005;65:1316–1318.PubMedGoogle Scholar
  7. 7.
    Kapur J, Macdonald RL. Rapid seizure-induced reduction of benzodiazepine and Zn2+ sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci. 1997;17:7532–7540.PubMedGoogle Scholar
  8. 8.
    Aminoff MJ, Simon RP. Status epilepticus. Causes, clinical features and consequences in 98 patients. Am J Med. 1980;69:657–666.PubMedGoogle Scholar
  9. 9.
    Towne AR, Pellock JM, Ko D, et al. Determinants of mortality in status epilepticus. Epilepsia. 1994;35:27–34.PubMedGoogle Scholar
  10. 10.
    Holtkamp M, Othman J, Buchheim K, et al. A “malignant” variant of status epilepticus. Arch Neurol. 2005;62:1428–1431.PubMedGoogle Scholar
  11. 11.
    Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med. 2001;345:631–637.PubMedGoogle Scholar
  12. 12.
    Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatment for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998;339:792–798.PubMedGoogle Scholar
  13. 13.
    Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5:246–256.PubMedGoogle Scholar
  14. 14.
    Proposal for revised clinical and electroencephalographic classification of epileptic seizures: from the Commission on Classification and Terminology of the International League against Epilepsy. Epilepsia 1981;22:489–501.Google Scholar
  15. 15.
    Mayer SA, Claassen J, Lokin J, et al. Refractory status epilepticus. Frequency, risk factors, and impact on outcome. Arch Neurol. 2002;59:205–210.PubMedGoogle Scholar
  16. 16.
    Bleck TP. Refractory status epilepticus. Curr Opin Crit Care. 2005;11:117–120.PubMedGoogle Scholar
  17. 17.
    DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46:1029–1035.PubMedGoogle Scholar
  18. 18.
    Hesdorffer DC, Logroscino G, Cascino G, et al. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology. 1998;50:735–741.PubMedGoogle Scholar
  19. 19.
    Coeytaux A, Jallon P, Galobardes B, Morabia A, et al. Incidence of status epilepticus in French-speaking Switzerland (EPISTAR). Neurology. 2000;55:693–697.PubMedGoogle Scholar
  20. 20.
    Knake S, Rosenow F, Vescovi M, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia. 2001;42:714–718.PubMedGoogle Scholar
  21. 21.
    Wu YW, Shek DW, Garcia PA, et al. Incidence and mortality of generalized convulsive status epilepticus in California. Neurology. 2002;58:1070–1076.PubMedGoogle Scholar
  22. 22.
    Claassen J, Mayer SA, Kowalski RG, et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62:1743–1748.PubMedGoogle Scholar
  23. 23.
    Logroscino G, Hesdorffer DC, Cascino G, et al. Mortality after a first episode of status epilepticus in the United States and Europe. Epilepsia. 2005;46:46–48.PubMedGoogle Scholar
  24. 24.
    Holtkamp M, Othman J, Buchheim K, et al. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005;76:534–539.PubMedGoogle Scholar
  25. 25.
    Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol. 2006;62:1698–1702.Google Scholar
  26. 26.
    Rossetti AO, Hurwitz S, Logroscino G, et al. Prognosis of status epilepticus: role of etiology, age, and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry. 2006;77:611–615.PubMedGoogle Scholar
  27. 27.
    Lowenstein DH, Allredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology. 1993;43:483–488.PubMedGoogle Scholar
  28. 28.
    Logroscino G, Hesdorffer DC, Cascino GD, et al. Short-term mortality after a first episode of status epilepticus. Epilepsia. 1997;38:1344–1349.PubMedGoogle Scholar
  29. 29.
    van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351:1849–1859.PubMedGoogle Scholar
  30. 30.
    Wang KW, Chang WN, Chang HW, et al. The significance of seizures and other predictive factors during the acute illness for the long-term outcome after bacterial meningitis. Seizure. 2005;14:586–592.PubMedGoogle Scholar
  31. 31.
    Pepperell C, Rau N, Krajden S, et al. West Nile virus infection in 2002: morbidity and mortality among patients admitted to hospital in southcentral Ontario. CMAJ. 2003;168:1399–1405.PubMedGoogle Scholar
  32. 32.
    Raschilas F, Wolff M, Delatour F, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients. Clin Infect Dis. 2002;35:254–260.PubMedGoogle Scholar
  33. 33.
    Solomon T. Flavivirus encephalitis. N Engl J Med. 2004;351:370–378.PubMedGoogle Scholar
  34. 34.
    Bleck TP, Smith MC, Pierre-Louis SJ, et al. Neurologic complications of critical medical illnesses. Crit Care Med. 1993;21:98–103.PubMedGoogle Scholar
  35. 35.
    Widjdicks EF, Sharbrough FW. New-onset seizures in critically ill patients. Neurology. 1993;43:1042–1044.Google Scholar
  36. 36.
    Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med. 1986;314:1529–1535.PubMedGoogle Scholar
  37. 37.
    Chow KM, Wang AY, Hui AC, et al. Nonconvulsive status epilepticus in peritoneal dialysis patients. Am J Kidney Dis. 2001;38:400–405.PubMedGoogle Scholar
  38. 38.
    Ellis AJ, Wendon JA, Williams R. Subclinical seizure activity and prophylactic phenytoin infusion in acute liver failure: a controlled clinical trial. Hepatology. 2000;32:536–541.PubMedGoogle Scholar
  39. 39.
    Bhatia V, Batra Y, Acharya SK. Prophylactic phenytoin does not improve cerebral edema or survival in acute liver failure – a controlled clinical trial. J Hepatol. 2004;41:89–96.PubMedGoogle Scholar
  40. 40.
    Schuckit A, Tipp JE, Reich T, et al. The histories of withdrawal convulsions and delirium tremens in 1648 alcohol dependent subjects. Addiction. 1995;90:1335–1347.PubMedGoogle Scholar
  41. 41.
    Rathlev NK, Ulrich AS, Delanty N, et al. Alcohol-related seizures. J Emerg Med. 2006;31:157–163.PubMedGoogle Scholar
  42. 42.
    Victor M, Brausch G. The role of abstinence in the genesis of alcoholic epilepsy. Epilepsia. 1967;8:1–20.PubMedGoogle Scholar
  43. 43.
    Ng SK, Hauser WA, Brust JC. Alcohol withdrawal and consumption in new-onset seizures. N Engl J Med. 1988;319:666–673.PubMedGoogle Scholar
  44. 44.
    D’Onofrio G, Rathlev NK, Ulrich AS, et al. Lorazepam for the prevention of recurrent seizures related to alcohol. N Engl J Med. 1999;340:915–919.PubMedGoogle Scholar
  45. 45.
    Allredge BK, Lowenstein DH. Status epilepticus related to alcohol abuse. Epilepsia. 1993;34:1033–1037.Google Scholar
  46. 46.
    Olson KR, Kearney TE, Dyer JE, et al. Seizures associated with poisoning and drug overdose. Am J Emerg Med. 1994;12:392–395.PubMedGoogle Scholar
  47. 47.
    Schifano F, Corkery J, Deluca P, et al. Ectasy (MDMA, MDA, MDEA, MBDB) consumption, seizures, related offences, prices, dosage levels and deaths in the UK (1994–2003). J Psychopharmacol. 2006;20:456–463.PubMedGoogle Scholar
  48. 48.
    Glantz MJ, Cole BF, Forsyth PA, et al. Practice parameter: anticonvulsant prophylaxis in patients with newly diagnosed brain tumors. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;54:1886–1893.PubMedGoogle Scholar
  49. 49.
    Forsyth PA, Weaver S, Fulton D, et al. Prophylactic anticonvulsants in patients with brain tumour. Can J Neurol Sci. 2003;30:106–112.PubMedGoogle Scholar
  50. 50.
    Annegers JF, Hauser WA, Coan SP, et al. A population-based study of seizures after traumatic brain injuries. N Engl J Med. 1998;338:20–24.PubMedGoogle Scholar
  51. 51.
    Vespa PM, Nuwer MR, Nenov V, et al. Increased incidence and impact of nonconvulsive and convulsive seizures after traumatic brain injury as detected by continuous electroencephalographic monitoring. J Neurosurg. 1999;91:750–760.PubMedGoogle Scholar
  52. 52.
    Peets AD, Berthiaume LR, Bagshaw SM, et al. Prolonged refractory status epilepticus following acute traumatic brain injury: a case report of excellent neurological recovery. Crit Care. 2005;9:725–728.Google Scholar
  53. 53.
    Temkin NR, Dikmen SS, Wilensky AJ, et al. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990;323:497–502.PubMedGoogle Scholar
  54. 54.
    Velioglu SK, Ozmenoglu M, Boz C, et al. Status epilepticus after stroke. Stroke. 2001;32:1169–1172.PubMedGoogle Scholar
  55. 55.
    Labovitz DL, Hauser WA, Sacco RL. Prevalence and predictors of early seizure and status epilepticus after first stroke. Neurology. 2001;57:200–206.PubMedGoogle Scholar
  56. 56.
    So EL, Annegers JF, Hauser WA, et al. Population-based study of seizure disorders after cerebral infarction. Neurology. 1996;46:350–355.PubMedGoogle Scholar
  57. 57.
    Burn J, Dennis M, Bamford J, et al. Epileptic seizures after a first stroke: the Oxfordshire community stroke project. BMJ. 1997;315:1582.PubMedGoogle Scholar
  58. 58.
    Rumbach L, Sablot D, Berger E, et al. Status epilepticus in stroke: report on a hospital-based stroke cohort. Neurology. 2000;54:350–354.PubMedGoogle Scholar
  59. 59.
    Passero S, Rocchi R, Rossi S, et al. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia. 2002;43:1175–1180.PubMedGoogle Scholar
  60. 60.
    Broderick JP, Adams HP Jr, Barasn W, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999;30:905–915.PubMedGoogle Scholar
  61. 61.
    Mayberg MR, Batjer HH, Dacey R, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Circulation. 1994;90:2592–2605.PubMedGoogle Scholar
  62. 62.
    Naidech AM, Kreiter KT, Janjua N, et al. Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke. 2005;36:583–587.PubMedGoogle Scholar
  63. 63.
    Vespa PM, O’Phelan K, Shah M, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003;60:1441–1446.PubMedGoogle Scholar
  64. 64.
    Dennis LJ, Claassen J, Hirsch LJ, et al. Non-convulsive status epilepticus after subarachnoid hemorrhage. Neurosurgery. 2002;51:1136–1143.PubMedGoogle Scholar
  65. 65.
    Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352:1791–1798.PubMedGoogle Scholar
  66. 66.
    Walton NY, Treiman DM. Response of status epilepticus induced by lithium and pilocarpine to treatment with diazepam. Exp Neurol. 1988;101:267–275.PubMedGoogle Scholar
  67. 67.
    Jones D, Esmaeil N, Maren S, et al. Characterization of pharmacoresistance to benzodiazepines in the rat li-pilocarpine model of status epilepticus. Epilepsy Res. 2002;50:301.PubMedGoogle Scholar
  68. 68.
    Goodkin HP, Yeh JL, Kapur J. Status epilepticus increases the intracellular accumulation of GABAA receptors. J Neurosci. 2005;25:5511–5520.PubMedGoogle Scholar
  69. 69.
    During MJ, Spencer DD. Extracellular hippocampal glutamate and spontaneous seizure in the conscious human brain. Lancet. 1993;26(341):1607–1610.Google Scholar
  70. 70.
    Williamson JM, Lothman EW. The effect of MK-801 on kindled seizures: implications for use and limitations as an antiepileptic drug. Ann Neurol. 1989;26:85–90.PubMedGoogle Scholar
  71. 71.
    Borris DJ, Bertram EH, Kapur J. Ketamine controls prolonged status epilepticus. Epilepsy Res. 2000;42:117–122.PubMedGoogle Scholar
  72. 72.
    Prasad A, Williamson JM, Bertram EH. Phenobarbital and MK-801, but not phenytoin, improve the long-term outcome of status epilepticus. Ann Neurol. 2002;51:175–181.PubMedGoogle Scholar
  73. 73.
    Meldrum BS, Brierley JB. Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. Arch Neurol. 1973;28:10–17.PubMedGoogle Scholar
  74. 74.
    Meldrum BS, Vigouroux RA, Brierley JB. Systemic factors and epileptic brain damage. Arch Neurol. 1973;29:87.Google Scholar
  75. 75.
    Nevander G, Ingvar M, Auer R, et al. Status epilepticus in well-oxygenated rats causes neuronal necrosis. Ann Neurol. 1985;18:281–290.PubMedGoogle Scholar
  76. 76.
    DeGiorgio CM, Tomiyasu U, Gott PS, et al. Hippocampal pyramidal cell loss in human status epilepticus. Epilepsia. 1992;33:23–27.PubMedGoogle Scholar
  77. 77.
    DeGiorgio CM, Heck CN, Rabinowicz AL, et al. Serum neuron-specific enolase in the major subtypes of status epilepticus. Neurology. 1999;52:746–749.PubMedGoogle Scholar
  78. 78.
    Szabo K, Poepel A, Pohlmann-Eden B, et al. Diffusion-weighted and perfusion MRI demonstrates parenchymal changes in complex partial status epilepticus. Brain. 2005;128:1369–1376.PubMedGoogle Scholar
  79. 79.
    Lansberg MG, O’Brien MW, Norbash AM, et al. MRI abnormalities associated with partial status epilepticus. Neurology. 1999;52:1021–1027.PubMedGoogle Scholar
  80. 80.
    Bruehl C, Hagemann G, Witte OW. Uncoupling of blood flow and metabolism in focal epilepsia. Epilepsia. 1998;39:1235–1242.PubMedGoogle Scholar
  81. 81.
    Cole AJ. Status epilepticus and periictal imaging. Epilepsia. 2004;45:72–77.PubMedGoogle Scholar
  82. 82.
    Lazeyras F, Blanke O, Zimine I, et al. MRI, (1)H-MRS, and functional MRI during and after prolonged nonconvulsive seizure activity. Neurology. 2000;5:1677–1682.Google Scholar
  83. 83.
    Parmar H, Lim SH, Tan N, et al. Acute symptomatic seizures and hippocampus damage: DWI and MRS findings. Neurology. 2006;6:1732–1735.Google Scholar
  84. 84.
    Hesdorffer DC, Logroscino G, Cascino G, et al. Risk of unprovoked seizure after acute symptomatic seizure: effect of status epilepticus. Ann Neurol. 1998;44:908–912.PubMedGoogle Scholar
  85. 85.
    Wijdicks EF, Hubmayr RD. Acute acid-base disorders associated with status epilepticus. Mayo Clin Proc. 1994;69:1044–1046.PubMedGoogle Scholar
  86. 86.
    Giffard RG, Monyer H, Christine CW, et al. Acidosis reduces NMDA receptor activation, glutamate neurotoxicity, and oxygen-glucose deprivation neuronal injury in cortical cultures. Brain Res. 1990;506:339–342.PubMedGoogle Scholar
  87. 87.
    Maron MB. Pulmonary vasoconstriction in a canine model of neurogenic pulmonary edema. J Appl Physiol. 1990;68:912–918.PubMedGoogle Scholar
  88. 88.
    Smith WS, Matthay MA. Evidence for a hydrostatic mechanism in human neurogenic pulmonary edema. Chest. 1997;111:1326–1333.PubMedGoogle Scholar
  89. 89.
    Manno EM, Pfeifer EA, Cascino GD, et al. Cardiac pathology in status epilepticus. Ann Neurol. 2005;58:954–957.PubMedGoogle Scholar
  90. 90.
    Young RS, Fripp RR, Yagel SK, et al. Cardiac dysfunction during status epilepticus in the neonatal pig. Ann Neurol. 1985;18:291–297.PubMedGoogle Scholar
  91. 91.
    Boggs JG, Painter JA, DeLorenzo RJ. Analysis of electrocardiographic changes in status epilepticus. Epilepsy Res. 1993;14:87–94.PubMedGoogle Scholar
  92. 92.
    Lundgren J, Smith ML, Blennow G, et al. Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Exp Brain Res. 1994;99:43–55.PubMedGoogle Scholar
  93. 93.
    Singhal PC, Chugh KS, Gulati DR. Myoglobinuria and renal failure after status epilepticus. Neurology. 1978;28:200–201.PubMedGoogle Scholar
  94. 94.
    DeLorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39:833–840.PubMedGoogle Scholar
  95. 95.
    Lowenstein DH, Aminoff MJ. Clinical and EEG features of status epilepticus in comatose patients. Neurology. 1992;42:100–104.PubMedGoogle Scholar
  96. 96.
    Husain AM, Horn GJ, Jacobson MP. Non-convulsive status epilepticus: usefulness of clinical features in selecting patients for urgent EEG. J Neurol Neurosurg Psychiatry. 2003;74:189–191.PubMedGoogle Scholar
  97. 97.
    Towne AR, Waterhouse EJ, Boggs J, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54:340–345.PubMedGoogle Scholar
  98. 98.
    Lowensttein DH, Alldredge BK. Status epilepticus. N Engl J Med. 1998;338:970–976.Google Scholar
  99. 99.
    Walton NY, Treiman DM. Lorazepam treatment of experimental status epilepticus in the rat: relevance to clinical practice. Neurology. 1990;40:990–994.PubMedGoogle Scholar
  100. 100.
    Cock HR, Schapira AH. A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM. 2002;95:225–231.PubMedGoogle Scholar
  101. 101.
    Appleton R, Sweeney A, Choonara I, et al. Lorazepam versus diazepam in the acute treatment of epileptic seizures and status epilepticus. Dev Med Child Neurol. 1995;37:682–688.PubMedGoogle Scholar
  102. 102.
    Chiulli DA, Terndrup TE, Kanter RK. The influence of diazepam or lorazepam on the frequency of endotracheal intubation in childhood status epilepticus. J Emerg Med. 1991;9:13–17.PubMedGoogle Scholar
  103. 103.
    Leppik IE, Derivan AT, Homan RW, et al. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA. 1983;249:1452–1454.PubMedGoogle Scholar
  104. 104.
    Qureshi A, Wassmer E, Davies P, et al. Comparative audit of intravenous lorazepam and diazepam in the emergency treatment of convulsive status epilepticus in children. Seizure. 2002;11:141–144.PubMedGoogle Scholar
  105. 105.
    Prasad K, Al-Roomi K, Krishnan PR, et al. Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev. 2005;19:CD003723.Google Scholar
  106. 106.
    Chamberlain JM, Altieri MA, Futterman C, et al. A prospective, randomized study comparing intramuscular midazolam with intravenous diazepam for the treatment of seizures in children. Pediatr Emerg Care. 1997;13:92–94.PubMedGoogle Scholar
  107. 107.
    McIntyre J, Robertson S, Norris E, et al. Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet. 2005;366:182–183.Google Scholar
  108. 108.
    Lahat E, Goldman M, Barr J, et al. Intranasal midazolam for childhood seizures. Lancet. 1998;352:620.PubMedGoogle Scholar
  109. 109.
    Scott RC, Besag FM, Neville BG. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet. 1999;353:623–626.PubMedGoogle Scholar
  110. 110.
    Cereghino JJ, Cloyd JC, Kuzniecky RI. Rectal diazepam gel for treatment of acute repetitive seizures in adults. Arch Neurol. 2002;59:1915–1920.PubMedGoogle Scholar
  111. 111.
    Claassen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. J Neurol Sci. 2003;211:37–41.PubMedGoogle Scholar
  112. 112.
    Earnest MP, Marx JA, Drury LR. Complications of intravenous phenytoin for acute treatment of seizures. Recommendations for usage. JAMA. 1983;249:762–765.PubMedGoogle Scholar
  113. 113.
    Spengler RF, Arrowsmith JB, Kilarski DJ, et al. Severe soft-tissue injury following intravenous infusion of phenytoin. Patient and drug administration risk factors. Arch Intern Med. 1988;148:1329–1333.PubMedGoogle Scholar
  114. 114.
    O’Brien TJ, Cascino GD, So EL, et al. Incidence and clinical consequences of the purple-glove syndrome in patients receiving intravenous phenytoin. Neurology. 1998;51:1034–1039.PubMedGoogle Scholar
  115. 115.
    Knapp LE, Kugler AR. Clinical experience with fosphenytoin in adults: pharmacokinetics, safety, and efficacy. J Child Neurol. 1998;13:S15–S18.PubMedGoogle Scholar
  116. 116.
    Fischer JH, Patel TV, Fischer PA. Fosphenytoin: clinical pharmacokinetics and comparative advantages in the acute treatment of seizures. Clin Pharmacokinet. 2003;42:33–58.PubMedGoogle Scholar
  117. 117.
    Martyn JA, Richtsfeld M, Warner DO. Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology. 2006;104:158–169.PubMedGoogle Scholar
  118. 118.
    Kumar A, Bleck TB. Intravenous midazolam for the treatment of refractory status epilepticus. Crit Care Med. 1992;20:483–488.PubMedGoogle Scholar
  119. 119.
    Claassen J, Hirsch LJ, Emerson RG, et al. Continuous EEG monitoring and midazolam infusion for refractory convulsive status epilepticus. Neurology. 2001;57:1036–1042.PubMedGoogle Scholar
  120. 120.
    Morrison G, Gibbons E, Whitehous WP. High-dose midazolam therapy for refractory status epilepticus in children. Intensive Care Med. 2006;32:2070–2076.PubMedGoogle Scholar
  121. 121.
    Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119–141.PubMedGoogle Scholar
  122. 122.
    Ostermann ME, Keenan SP, Seiferling RA, et al. Sedation in the intensive care unit: a systematic review. JAMA. 2000;283:1451–1459.PubMedGoogle Scholar
  123. 123.
    Chaorro C, de Laorre FJ, Montero A, et al. Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial. Crit Care Med. 1996;24:932–939.Google Scholar
  124. 124.
    Hutchens MP, Memtsoudis S, Sadovnikoff N. Propofol for sedation in neuro-intensive care. Neurocrit Care. 2006;4:54–62.PubMedGoogle Scholar
  125. 125.
    Smith M, Smith SJ, Scott CA, et al. Activation of the electrocorticogram by propofol during surgery for epilepsy. Br J Anesth. 1996;76:499–502.Google Scholar
  126. 126.
    Walder B, Tramer MR, Seek M. Seizure-like phenomena and propofol: a systematic review. Neurology. 2002;58:1327–1332.PubMedGoogle Scholar
  127. 127.
    Stecker MM, Kramer TH, Raps EC, et al. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia. 1998;39:18–26.PubMedGoogle Scholar
  128. 128.
    Rossetti AO, Reichhart MD, Schaller MD, et al. Propofol treatment of refractory status epilepticus: a study of 31 episodes. Epilepsia. 2004;45:757–763.PubMedGoogle Scholar
  129. 129.
    Parviainen I, Uusaro A, Lalviainen R, et al. Propofol in the treatment of refractory status epilepticus. Intensive Care Med. 2006;32:1075–1079.PubMedGoogle Scholar
  130. 130.
    van Gestel JP, Blusse van Oud-Alblas HJ, Malingre M, et al. Propofol and thiopental for refractory status epilepticus in children. Neurology. 2005;65:591–592.PubMedGoogle Scholar
  131. 131.
    Prasad A, Worrall BB, Bertram EH, et al. Propofol and midazolam in the treatment of refractory status epilepticus. Epilepsia. 2001;42:380–386.PubMedGoogle Scholar
  132. 132.
    Cremer OL, Moons KG, Bouman EA, et al. Long-term propofol infusion and cardiac failure in adult head-injured patients. Lancet. 2001;357:117–118.PubMedGoogle Scholar
  133. 133.
    Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med. 2003;29:1417–1425.PubMedGoogle Scholar
  134. 134.
    Rashkin MC, Youngs C, Penovich P. Pentobarbital treatment of refractory status epilepticus. Neurology. 1987;37:500–503.PubMedGoogle Scholar
  135. 135.
    Lowenstein DH, Aminoff MJ, Simon RP. Barbiturate anesthesia in the treatment of refractory status epilepticus. Neurology. 1988;38:395–400.PubMedGoogle Scholar
  136. 136.
    Young GB, Blume WT, Bolton CF, et al. Anesthetic barbiturates in refractory status epilepticus. Can J Neurol Sci. 1980;7:291–292.PubMedGoogle Scholar
  137. 137.
    Parviainen I, Uusaro A, Kalviainen R, et al. High-dose thiopental in the treatment of refractory status epilepticus in intensive care unit. Neurology. 2002;59:1249–1251.PubMedGoogle Scholar
  138. 138.
    Yaffe K, Lowenstein DH. Prognostic factors of pentobarbital therapy for refractory generalized status epilepticus. Neurology. 1993;43:895–900.PubMedGoogle Scholar
  139. 139.
    Ala-Kokko TI, Saynajakangas P, Laurila P, et al. Incidence of infections in patients with status epilepticus requiring intensive care and effect on resource utilization. Anaesth Intensive Care. 2006;34:639–644.PubMedGoogle Scholar
  140. 140.
    Galley HF, DiMatteo MA, Webster NR. Immunomodulation by anesthetic, sedative and analgesic agents: does it matter? Intensive Care Med. 2000;26:267–274.PubMedGoogle Scholar
  141. 141.
    Ploppa A, Kiefer RT, Nohe B, et al. Dose-dependent influence of barbiturates but not propofol on human leukocyte phagocytosis of viable Staphylococcus aureus. Crit Care Med. 2006;34:478–483.PubMedGoogle Scholar
  142. 142.
    Claassen J, Hirsch LJ, Emerson RG, et al. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43:146–153.PubMedGoogle Scholar
  143. 143.
    Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol. 2005;62:1698–1702.PubMedGoogle Scholar
  144. 144.
    Limdi LA, Shimpi AV, Faught E, et al. Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology. 2005;64:353–355.PubMedGoogle Scholar
  145. 145.
    Venkataraman V, Wheless JW. Safety of rapid infusion of valproate loading doses in epilepsy patients. Epilepsy Res. 1999;35:147–153.PubMedGoogle Scholar
  146. 146.
    Wheless JW, Vazquez BR, Kanner AM, et al. Rapid infusion with valproate sodium is well tolerated in patients with epilepsy. Neurology. 2004;63:1507–1508.PubMedGoogle Scholar
  147. 147.
    Ueberall MA, Trollman R, Wunsiedler U, et al. Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology. 2000;54:2188–2189.Google Scholar
  148. 148.
    Peters CN, Pohlmann-Eden B. Intravenous valproate as an innovative therapy in seizure emergency situations including status epilepticus–experience in 102 adult patients. Seizure. 2005;14:164–169.PubMedGoogle Scholar
  149. 149.
    Sinha S, Naritoku DK. Intravenous valproate is well tolerated in unstable patients with status epilepticus. Neurology. 2000;55:722–724.PubMedGoogle Scholar
  150. 150.
    Misra UK, Kalita J, Patel R. Sodium valproate vs phenytoin in status epilepticus: a pilot. Neurology. 2006;67:340–342.PubMedGoogle Scholar
  151. 151.
    Yen W, Williamson J, Bertram EH, et al. A comparison of three NMDA receptor antagonists in the treatment of prolonged status epilepticus. Epilepsy Res. 2004;59:43–50.PubMedGoogle Scholar
  152. 152.
    Nathan B, Smith TL, Bleck TB. The use of ketamine in the treatment of refractory status epilepticus. Neurology. 2002;3:A197.Google Scholar
  153. 153.
    Mewasingh LD, Sekhara T, Aeby A, et al. Oral ketamine in pediatric non-convulsive status epilepticus. Seizure. 2003;12:483–489.PubMedGoogle Scholar
  154. 154.
    Ubogu EE, Sagar SM, Lerner AJ, et al. Ketamine for refractory status epilepticus: a case of possible induced neurotoxicity. Epilepsy Behav. 2003;4:70–75.PubMedGoogle Scholar
  155. 155.
    Himmelseher S, Dureiux ME. Revising a dogma: ketamine for patients with neurological injury? Anesth Analg. 2005;101:524–534.PubMedGoogle Scholar
  156. 156.
    Towne AR, Garnett LK, Waterhouse EJ, et al. The use of topiramate in refractory status epilepticus. Neurology. 2003;60:332–334.PubMedGoogle Scholar
  157. 157.
    Traulli A, Drislane FW. The use of topiramate in refractory status epilepticus. Neurology. 2004;62:837.Google Scholar
  158. 158.
    Bensalem MK, Fakhoury TA. Topiramate and status epilepticus: report of three cases. Epilepsy Behav. 2003;4:757–760.PubMedGoogle Scholar
  159. 159.
    Rossetti AO, Bromfield EB. Levetiracetam in the treatment of status epilepticus in adults: a study of 13 episodes. Eur Neurol. 2005;54:34–38.PubMedGoogle Scholar
  160. 160.
    Rupprecht S, Franke K, Tizek S, et al. Levetiracetam as a treatment option in non-convulsive status epilepticus. Epilepsy Res. 2007;73(3):238–244.PubMedGoogle Scholar
  161. 161.
    Patel NC, Landan IR, Levin J, et al. The use of levetiracetam in refractory status epilepticus. Seizure. 2006;15:137–141.PubMedGoogle Scholar
  162. 162.
    Wijdicks EF, Parisi JE, Sharbrough FW. Prognostic value of myoclonic status in comatose survivors of cardiac arrest. Ann Neurol. 1994;35:239–243.PubMedGoogle Scholar
  163. 163.
    Krishnamurthy KB, Drislane FW. Relapse and survival after barbiturate anesthetic treatment of refractory status epilepticus. Epilepsia. 1996;37:863–867.PubMedGoogle Scholar
  164. 164.
    Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999;40:759–762.PubMedGoogle Scholar
  165. 165.
    Van Ness PC. Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin. Epilepsia. 1990;31:61–67.PubMedGoogle Scholar
  166. 166.
    Litt B, Wityk RJ, Hertz SH, et al. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia. 1998;39:1194–1202.PubMedGoogle Scholar
  167. 167.
    Abou Khaled KJ, Hirsch LJ. Advances in the management of seizures and status epilepticus in critically ill patients. Crit Care Clin. 2006;22:637–659.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Andreas H. Kramer
    • 1
  • Thomas P. Bleck
    • 2
  • Thomas P. Bleck
    • 3
  1. 1.Department of Critical Care Medicine and Clinical NuerosciencesUniversity of CalgaryAlbertaCanada
  2. 2.Rush Medical CollegeChicagoUSA
  3. 3.Rush University Medical CenterChicagoUSA

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