EFNS guideline on the management of status epilepticus
- 22 May 2006
- journal article
- practice guideline
- Published by Wiley in European Journal of Neurology
- Vol. 13 (5), 445-450
- https://doi.org/10.1111/j.1468-1331.2006.01397.x
Abstract
The objective of the current paper was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4 mg of lorazepam or 10 mg of diazepam directly followed by 15-18 mg/kg of phenytoin or equivalent fosphenytoin. If seizures continue for more than 10 min after first injection another 4 mg of lorazepam or 10 mg of diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of midazolam, propofol or barbiturates; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non-convulsive SE depends on the type and the cause. In most cases of absence SE, a small i.v. dose of lorazepam or diazepam will terminate the attack. Complex partial SE is initially treated such as GCSE, however, when refractory further non-anaesthetising substances should be given instead of anaesthetics. In subtle SE i.v. anaesthesia is required.Keywords
This publication has 42 references indexed in Scilit:
- Transient loss of inhibition precedes spontaneous seizures after experimental status epilepticusNeurobiology of Disease, 2005
- The management of refractory generalised convulsive and complex partial status epilepticus in three European countries: a survey among epileptologists and critical care neurologistsJournal of Neurology, Neurosurgery & Psychiatry, 2003
- GABAA receptor function and pharmacology in epilepsy and status epilepticusCurrent Opinion in Pharmacology, 2003
- Incidence of Status Epilepticus in Adults in Germany: A Prospective, Population‐Based StudyEpilepsia, 2001
- How long do new‐onset seizures in children last?Annals of Neurology, 2001
- Halothane as a Neuroprotectant During Constant Stimulation of the Perforant PathEpilepsia, 1999
- Status EpilepticusNew England Journal of Medicine, 1998
- Nonconvulsive Status EpilepticusSeminars in Neurology, 1996
- Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America's Working Group on Status EpilepticusPublished by American Medical Association (AMA) ,1993
- Proposal for Revised Clinical and Electroencephalographic Classification of Epileptic SeizuresEpilepsia, 1981