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Early Treatment of Convulsive Status Epilepticus

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Status Epilepticus

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

The management of convulsive status epilepticus (CSE) consists of simultaneous termination of the status epilepticus (SE) and determination and management of the underlying etiology. The operational definition of CSE is seizure activity lasting for more than 5 min or recurrent seizure activity with no recovery in between. Management of SE consists of stabilizing the patient along with early administration of abortive therapy and initiation of the workup for an underlying etiology. Early treatment of SE often starts with the use of benzodiazepines, best administered via parenteral route, based on recommendations by the American Epilepsy Society, Neurocritical Care Society, and the European Federation of Neurological Societies. Various formulations of midazolam, diazepam, and lorazepam have been investigated for out-of-hospital treatment of CSE. Subsequent second-line therapy consists of parenteral anti-seizure drugs (ASD) including phenytoin, phenobarbital, valproic acid, levetiracetam, and lacosamide. Evidence supporting the use of many of these ASDs is still lacking or being evaluated.

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References

  1. Rosenow F, Hamer HM, Knake S. The epidemiology of convulsive and nonconvulsive status epilepticus. Epilepsia. 2007;48(Suppl 8):82–4.

    Article  PubMed  Google Scholar 

  2. Logroscino G, Hesdorffer DC, Cascino G, Hauser WA, Coeytaux A, Galobardes B, et al. Mortality after a first episode of status epilepticus in the United States and Europe. Epilepsia. 2005;46(Suppl 11):46–8.

    Article  PubMed  Google Scholar 

  3. Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40(1):120–2.

    Article  CAS  PubMed  Google Scholar 

  4. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus—report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–23.

    Article  PubMed  Google Scholar 

  5. Sloviter RS. Status epilepticus-induced neuronal injury and network reorganization. Epilepsia. 1999;40(Suppl 1):S34–9; (discussion S40-1).

    Google Scholar 

  6. Falco-Walter JJ, Bleck T. Treatment of Established Status Epilepticus. J Clin Med. 2016;5(5).

    Google Scholar 

  7. Unterberger I. Status epilepticus: do treatment guidelines make sense? J Clin Neurophysiol. 2016;33(1):10–3.

    Article  PubMed  Google Scholar 

  8. Runge JW, Allen FH. Emergency treatment of status epilepticus. Neurology. 1996;46(6 Suppl 1):S20–3.

    Article  CAS  PubMed  Google Scholar 

  9. Meierkord H, Boon P, Engelsen B, Gocke K, Shorvon S, Tinuper P, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010;17(3):348–55.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Smith DM, McGinnis EL, Walleigh DJ, Abend NS. Management of status epilepticus in children. J Clin Med. 2016;5(4) (pii: E47). doi:10.3390/jcm5040047.

  13. Jain P, Sharma S, Dua T, Barbui C, Das RR, Aneja S. Efficacy and safety of anti-epileptic drugs in patients with active convulsive seizures when no IV access is available: systematic review and meta-analysis. Epilepsy Res. 2016;122:47–55.

    Article  CAS  PubMed  Google Scholar 

  14. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998;339(12):792–8.

    Article  CAS  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. Dhillon S, Oxley J, Richens A. Bioavailability of diazepam after intravenous, oral and rectal administration in adult epileptic patients. Br J Clin Pharmacol. 1982;13(3):427–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Agurell S, Berlin A, Ferngren H, Hellstrom B. Plasma levels of diazepam after parenteral and rectal administration in children. Epilepsia. 1975;16(2):277–83.

    Article  CAS  PubMed  Google Scholar 

  19. Cereghino JJ, Mitchell WG, Murphy J, Kriel RL, Rosenfeld WE, Trevathan E. Treating repetitive seizures with a rectal diazepam formulation: a randomized study. The North American Diastat Study Group. Neurology. 1998;51(5):1274–82.

    Article  CAS  PubMed  Google Scholar 

  20. Dreifuss FE, Rosman NP, Cloyd JC, Pellock JM, Kuzniecky RI, Lo WD, et al. A comparison of rectal diazepam gel and placebo for acute repetitive seizures. N Engl J Med. 1998;338(26):1869–75.

    Article  CAS  PubMed  Google Scholar 

  21. Scott RC, Besag FM, Boyd SG, Berry D, Neville BG. Buccal absorption of midazolam: pharmacokinetics and EEG pharmacodynamics. Epilepsia. 1998;39(3):290–4.

    Article  CAS  PubMed  Google Scholar 

  22. 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(9153):623–6.

    Article  CAS  PubMed  Google Scholar 

  23. McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, 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(9481):205–10.

    Article  CAS  PubMed  Google Scholar 

  24. Talukdar B, Chakrabarty B. Efficacy of buccal midazolam compared to intravenous diazepam in controlling convulsions in children: a randomized controlled trial. Brain Dev. 2009;31(10):744–9.

    Article  PubMed  Google Scholar 

  25. Knoester PD, Jonker DM, Van Der Hoeven RT, Vermeij TA, Edelbroek PM, Brekelmans GJ, et al. Pharmacokinetics and pharmacodynamics of midazolam administered as a concentrated intranasal spray. A study in healthy volunteers. Brit J Clin Pharmacol. 2002;53(5):501–7.

    Article  CAS  Google Scholar 

  26. Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M. Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ. 2000;321(7253):83–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, et al. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med. 2010;164(8):747–53.

    Article  PubMed  Google Scholar 

  28. Kalviainen R. Intranasal therapies for acute seizures. Epilepsy Behav. 2015;49:303–6.

    Article  PubMed  Google Scholar 

  29. Arya R, Gulati S, Kabra M, Sahu JK, Kalra V. Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. Epilepsia. 2011;52(4):788–93.

    Article  CAS  PubMed  Google Scholar 

  30. Malu CK, Kahamba DM, Walker TD, Mukampunga C, Musalu EM, Kokolomani J, et al. Efficacy of sublingual lorazepam versus intrarectal diazepam for prolonged convulsions in Sub-Saharan Africa. J Child Neurol. 2014;29(7):895–902.

    Article  PubMed  Google Scholar 

  31. Towne AR, DeLorenzo RJ. Use of intramuscular midazolam for status epilepticus. J Emerg Med. 1999;17(2):323–8.

    Article  CAS  PubMed  Google Scholar 

  32. Holazo AA, Winkler MB, Patel IH. Effects of age, gender and oral contraceptives on intramuscular midazolam pharmacokinetics. J Clin Pharmacol. 1988;28(11):1040–5.

    Article  CAS  PubMed  Google Scholar 

  33. Bell DM, Richards G, Dhillon S, Oxley JR, Cromarty J, Sander JW, et al. A comparative pharmacokinetic study of intravenous and intramuscular midazolam in patients with epilepsy. Epilepsy Res. 1991;10(2–3):183–90.

    Article  CAS  PubMed  Google Scholar 

  34. Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366(7):591–600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Portela JL, Garcia PC, Piva JP, Barcelos A, Bruno F, Branco R, et al. Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: a randomized clinical trial. Med Intensiva. 2015;39(3):160–6.

    Article  CAS  PubMed  Google Scholar 

  36. Treiman DM. The role of benzodiazepines in the management of status epilepticus. Neurology. 1990;40(5 Suppl 2):32–42.

    CAS  PubMed  Google Scholar 

  37. Walker JE, Homan RW, Vasko MR, Crawford IL, Bell RD, Tasker WG. Lorazepam in status epilepticus. Ann Neurol. 1979;6(3):207–13.

    Article  CAS  PubMed  Google Scholar 

  38. Shaner DM, McCurdy SA, Herring MO, Gabor AJ. Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology. 1988;38(2):202–7.

    Article  CAS  PubMed  Google Scholar 

  39. Browne TR. The pharmacokinetics of agents used to treat status epilepticus. Neurology. 1990;40(5 Suppl 2):28–32.

    CAS  PubMed  Google Scholar 

  40. Leppik IE, Sherwin AL. Intravenous phenytoin and phenobarbital: anticonvulsant action, brain content, and plasma binding in rat. Epilepsia. 1979;20(3):201–7.

    Article  CAS  PubMed  Google Scholar 

  41. Ramsay RE, Hammond EJ, Perchalski RJ, Wilder BJ. Brain uptake of phenytoin, phenobarbital, and diazepam. Arch Neurol. 1979;36(9):535–9.

    Article  CAS  PubMed  Google Scholar 

  42. Browne TR, Kugler AR, Eldon MA. Pharmacology and pharmacokinetics of fosphenytoin. Neurology. 1996;46(6 Suppl 1):S3–7.

    Article  CAS  PubMed  Google Scholar 

  43. DeToledo JC, Ramsay RE. Fosphenytoin and phenytoin in patients with status epilepticus: improved tolerability versus increased costs. Drug Saf. 2000;22(6):459–66.

    Article  CAS  PubMed  Google Scholar 

  44. Wilder BJ, Ramsay RE, Willmore LJ, Feussner GF, Perchalski RJ, Shumate JB Jr. Efficacy of intravenous phenytoin in the treatment of status epilepticus: kinetics of central nervous system penetration. Ann Neurol. 1977;1(6):511–8.

    Article  CAS  PubMed  Google Scholar 

  45. Wallis W, Kutt H, McDowell F. Intravenous diphenylhydantoin in treatment of acute repetitive seizures. Neurology. 1968;18(6):513–25.

    Article  CAS  PubMed  Google Scholar 

  46. Cranford RE, Leppik IE, Patrick B, Anderson CB, Kostick B. Intravenous phenytoin in acute treatment of seizures. Neurology. 1979;29(11):1474–9.

    Article  CAS  PubMed  Google Scholar 

  47. Naritoku DK, Mueed S. Intravenous loading of valproate for epilepsy. Clin Neuropharmacol. 1999;22(2):102–6.

    Article  CAS  PubMed  Google Scholar 

  48. Venkataraman V, Wheless JW. Safety of rapid intravenous infusion of valproate loading doses in epilepsy patients. Epilepsy Res. 1999;35(2):147–53.

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  50. Gilad R, Izkovitz N, Dabby R, Rapoport A, Sadeh M, Weller B, et al. Treatment of status epilepticus and acute repetitive seizures with i.v. valproic acid vs phenytoin. Acta Neurol Scand. 2008;118(5):296–300.

    Article  CAS  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. Chen WB, Gao R, Su YY, Zhao JW, Zhang YZ, Wang L, et al. Valproate versus diazepam for generalized convulsive status epilepticus: a pilot study. Eur J Neurol. 2011;18(12):1391–6.

    Article  CAS  PubMed  Google Scholar 

  53. Bleck TP. Management approaches to prolonged seizures and status epilepticus. Epilepsia. 1999;40(Suppl 1):S59–63 (discussion S4–6).

    Google Scholar 

  54. Misra UK, Kalita J, Maurya PK. LEV versus lorazepam in status epilepticus: a randomized, open labeled pilot study. J Neurol. 2012;259(4):645–8.

    Article  CAS  PubMed  Google Scholar 

  55. Abend NS, Monk HM, Licht DJ, Dlugos DJ. Intravenous levetiracetam in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med. 2009;10(4):505–10.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Aiguabella M, Falip M, Villanueva V, de la Pena P, Molins A, Garcia-Morales I, et al. Efficacy of intravenous levetiracetam as an add-on treatment in status epilepticus: a multicentric observational study. Seizure. 2011;20(1):60–4.

    Article  PubMed  Google Scholar 

  57. Alvarez V, Januel JM, Burnand B, Rossetti AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011;52(7):1292–6.

    Article  CAS  PubMed  Google Scholar 

  58. Goraya JS, Khurana DS, Valencia I, Melvin JJ, Cruz M, Legido A, et al. Intravenous levetiracetam in children with epilepsy. Ped Neurol. 2008;38(3):177–80.

    Article  Google Scholar 

  59. Santamarina E, Toledo M, Sueiras M, Raspall M, Ailouti N, Lainez E, et al. Usefulness of intravenous lacosamide in status epilepticus. J Neurol. 2013;260(12):3122–8.

    Article  CAS  PubMed  Google Scholar 

  60. Poddar K, Sharma R, Ng YT. Intravenous lacosamide in pediatric status epilepticus: an open-label efficacy and safety study. Ped Neurol. 2016;76:83–6.

    Article  Google Scholar 

  61. Husain A, Lee JW, Kolls B, Hirsch L, Halford J, Gupta P, et al. The trends trial: intravenous lacosamide versus fosphenytoin for the treatment of frequent nonconvulsive seizures in critically ill patients. Abstract 1.401, 2015. American Epilepsy Society Annual Meeting. https://www.aesnet.org/meetings_events/annual_meeting_abstracts/view/2398222. Accessed 31 Aug 2016.

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Authors and Affiliations

  1. Department of Pediatrics and Neurology, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, P.O. Box 13-5053, Chouran, Beirut, Lebanon

    Abeer J. Hani

  2. Department of Neurology, Duke University Medical Center, Box 102350, 299B Hanes House, 315 Trent Drive, Duke University Medical Center, Durham, NC, 27710, USA

    Aatif M. Husain

  3. Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC, 27705, USA

    Aatif M. Husain

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  1. Abeer J. Hani
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  2. Aatif M. Husain
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Correspondence to Aatif M. Husain .

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Editors and Affiliations

  1. Department of Neurology, Harvard Medical School, Comprehensive Epilepsy Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Frank W. Drislane

  2. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA

    Peter W. Kaplan MBBS

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Hani, A.J., Husain, A.M. (2018). Early Treatment of Convulsive Status Epilepticus. In: Drislane, F., Kaplan MBBS, P. (eds) Status Epilepticus. Current Clinical Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-58200-9_16

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  • DOI: https://doi.org/10.1007/978-3-319-58200-9_16

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