Management of status epilepticus in the intensive care unit

Abstract

Exact protocols for the treatment of status epilepticus (SE) in the ICU particularly if refractory to the initial interventions differ between centers. However, most agree on some basic principles and the initial management approach. Treatment of SE should be initiated as early as possible as delayed treatment will make seizures more difficult to control and clinical outcomes will be worse. Initial treatment should not be underdosed and most would treat nonconvulsive status epilepticus (NCSE) the same as convulsive status epilepticus (CSE). Most SE in the ICU is indeed not associated with convulsions and classified as NCSE. Therefore, continuous EEG monitoring should be mandatory, when treating status in the ICU as seizures may otherwise go undetected and as prolonged CSE will convert to NCSE. Several medications are available for treating seizures, but only few are available for parenteral, fast administration when treating status. The experience from using the newer antiepileptics in case of resistant status is therefore limited. Interactions between antiepileptics and common ICU medications may be significant and concurrent multi-organ failure may alter their metabolism.