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Nonpharmacologic Treatments of Status Epilepticus

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Status Epilepticus

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

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Abstract

When first- and second-line antiseizure drugs fail to stop status epilepticus, morbidity and mortality increase substantially. This chapter reviews adjunctive nonpharmacologic options for treating status epilepticus when standard drugs are ineffective. These treatments include therapeutic hypothermia, neurostimulation (electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation), ketogenic diet therapies (ketogenic diet, modified Atkins diet, low glycemic index treatment), intracranial procedures (resective surgery, corpus callosotomy, multiple subpial transection), and combination therapies. Evidence for the use of these treatments mostly comprises studies of animal models of status epilepticus, treatments for epilepsia partialis continua in humans, and retrospective case reports and case series in patients treated for refractory and super-refractory status epilepticus. Compared to morbidity and mortality rates reported in the literature with refractory and super-refractory status epilepticus, several of these treatments are promising in both children and adults. Prospective clinical trials are needed to establish the safety, feasibility, and efficacy of these treatments in status epilepticus and to determine the best approach for incorporating them into standard status epilepticus treatment algorithms. Background, potential mechanisms of action, treatment protocols, evidence for efficacy, side effects, and contraindications are described for each treatment modality.

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  1. Department of Neurology, The Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 2-147, Baltimore, MD, 21087, USA

    Mackenzie C. Cervenka

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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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Cervenka, M.C. (2018). Nonpharmacologic Treatments of 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_18

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