Pharmacotherapy and intensive care aspects of status epilepticus: update 2020/2021

Abstract

Focused treatment of epileptic emergencies, and in particular status epilepticus (SE), require a reliable differentiation of epileptic syndromes. In these cases, and especially in cases with predominant non-motor symptoms, clinical and electroencephalographic expertise is necessary. In 2020 the German guidelines for the management of SE were updated, which adhere to a strict stage-based treatment algorithm. The staged approach includes the administration of benzodiazepines, antiepileptic drugs and anesthetic agents. So far, efforts failed to determine the most effective and safest antiepileptic drug without interaction potential. Therefore, for the differentiated treatment of SE, individual pre-existing medical conditions and concomitant circumstances must be considered, added by the experience of the medical team. Therapeutic interventions especially for refractory forms of SE have been shown to be complex with relevant implications concerning intensive care aspects. Consequently, the modern treatment strategy of SE is characterized by an interdisciplinary approach. Future research is needed to define the optimal treatment of non-convulsive SE, in particular regarding the time point and degree of treatment escalation with associated ethical considerations.