Recent trends in the management of status epilepticus

Abstract

Status Epilepticus (SE) is a neurologic emergency associated with high morbidity and mortality. The etiology varies among the different age groups, and it has a U-shaped incidence curve, being more common at the extremes of ages. Mortality is rarely due to the status itself, and the outcome depends to a great extent on the underlying etiology and the presence of additional medical conditions. Outcome also depends on the rapidity of diagnosis and initiation of appropriate therapy. Anti-epileptic drug administration in appropriate doses should begin promptly after the suspicion of SE; intra-muscular midazolam and rectal diazepam administered by paramedical staff involved in transporting the patient also has been shown to shorten the duration of SE. Attention should be paid in the initial stages itself to airway patency, adequacy of breathing and ventilation, the circulatory status, securing intravenous access and identifying the underlying cause. The goals of therapy include rapid termination of clinical and electrical ictal activity, prevention of aspiration pneumonia, and treatment of complications in anticipation. Every hospital needs to manage SE on the basis of established protocols, and an early decision regarding artificial ventilation and midazolam or barbiturate anesthesia for refractory SE needs to be taken. With the existing protocols and available drugs, it is generally possible to control seizures and prevent complications and mortality.