Neurol. praxi. 2024;25(3):177-181 | DOI: 10.36290/neu.2024.038

Convulsive status epilepticus and its early treatment

doc. MUDr. Irena Doležalová, Ph.D.1, prof. MUDr. Petr Marusič, Ph.D.2
1 Centrum pro epilepsie Brno, člen ERN EpiCARE, I. neurologická klinika Fakultní nemocnice u sv. Anny a Lékařské fakulty Masarykovy univerzity, Brno
2 Centrum pro epilepsie Motol, člen ERN EpiCARE, Neurologická klinika 2. lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Motole, Praha

Convulsive status epilepticus is the form of a tonic-clonic seizure lasting longer than 5 minutes, or in the case of repeated tonic-clonic seizures within this time period. Initially is treated with benzodiazepines - diazepam i. v., midazolam i. m. or buccal, or diazepam administered rectally. If benzodiazepine therapy fails, intravenous administration of anti-seizure drugs is indicated - levetiracetam at 60 mg/kg (maximum 4500 mg), valproate at 40 mg/kg (maximum 3000 mg), or phenytoin at 20 mg/kg (maximum 1500 mg). In this article, we present maintenance doses of the drugs and discuss their important pharmacological properties and possible adverse effects. Finally, we mention other drugs potentially useful in the treatment of convulsive status epilepticus that are available in a form for intravenous administration - lacosamide and brivaracetam.

Keywords: convulsive status epilepticus, initial therapy, benozodiazepines, established status epilepticus, intravenous anti-seizure drugs.

Accepted: May 20, 2024; Prepublished online: May 20, 2024; Published: June 20, 2024  Show citation

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Doležalová I, Marusič P. Convulsive status epilepticus and its early treatment. Neurol. praxi. 2024;25(3):177-181. doi: 10.36290/neu.2024.038.
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    References

    1. Alldredge BK, Gelb AM, Isaacs SM, et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. The New England Journal of Medicine. 2001;345(9): 631-637. doi: 10.1056/NEJMoa002141. Go to original source... Go to PubMed...
    2. Asnis-alibozek A, Detyniecki K. The unmet need for rapid epileptic seizure termination (REST). Epilepsy & Behavior Reports. 2021;15. doi: 10.1016/j.ebr.2020.100409. Go to original source... Go to PubMed...
    3. Boucher BA. Fosphenytoin: a novel phenytoin prodrug. Pharmacotherapy. 1996;16:5:777-791. Go to original source...
    4. Brophy GM, et al. Guidelines for the evaluation and mana­gement of status epilepticus. Neurocritical Care. 2012;17(1): 3-23. doi: 10.1007/s12028-012-9695-z. Go to original source... Go to PubMed...
    5. Byun J. Management of convulsive status epilepticus: recent updates. Encephalitis (Seoul, Korea). 2012;3(2):39-43. doi: 10.47936/encephalitis.2022.00087. Go to original source... Go to PubMed...
    6. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. doi: 10.1159/000180580. Go to original source... Go to PubMed...
    7. French J, Biton V, Dave H, et al. A randomized phase 2b efficacy study in patients with seizure episodes with a predictable pattern using Staccato® alprazolam for rapid seizure termination. Epilepsia. 2023;64(2):374-385. doi: 10.1111/epi.17441. Go to original source... Go to PubMed...
    8. Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Currents. 2016;16:1:48-61. doi: 10.5698/1535-7597-16.1.48. Go to original source... Go to PubMed...
    9. Guldiken B, Rémi J., Noachtar S. Cardiovascular adverse effects of phenytoin. Journal of Neurology. 2016;263(5): 861-870. doi: 10.1007/s00415-015-7967-1. Go to original source... Go to PubMed...
    10. Chamberlain JM, Kapur J, Shinnar S, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. Lancet (London, England). 2020;395(10231):1217-1224. doi: 10.1016/S0140-6736(20)30611-5. Go to original source... Go to PubMed...
    11. Lattanzi S, Trinka E, Brigo F, et al. Clinical scores and clusters for prediction of outcomes in status epilepticus. Epilepsy & Behavior: E&B. 2023;140(109110). doi: 10.1016/j.yebeh.2023.109110. Go to original source... Go to PubMed...
    12. Li ZR, Wang CH, Zhu X, et al. Population Pharmacokinetics of Levetiracetam: A Systematic Review. Clinical Pharmacokinetics. 2021; 60(3):305-318. doi: 10.1007/s40262-020-00963-2. Go to original source... Go to PubMed...
    13. Maier S, et al. Recognition and treatment of status epilepticus in the prehospital setting. Seizure. 2021;86:1-5. doi: 10.1016/j.seizure.2020.12.014. Go to original source... Go to PubMed...
    14. Meierkord H, et al. EFNS guideline on the management of status epilepticus in adults. European Journal of Neurology. 2010;17(3):348-355. doi: 10.1111/j.1468-1331.2009.02917.x. Go to original source... Go to PubMed...
    15. Migdady I, Rosenthal ES, Cock HR. Management of status epilepticus: a narrative review. Anaesthesia. 2022;77(1):78-91. doi: 10.1111/anae.15606. Go to original source... Go to PubMed...
    16. Neligan A, Noyce AJ, Gosavi TD, et al. Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time: A Systematic Review and Meta-analysis. JAMA Neurology. 2019;76(8):897-905. doi: 10.1001/jamaneurol.2019.1268. Go to original source... Go to PubMed...
    17. Olanow CW, Finn AL. Phenytoin: pharmacokinetics and clinical therapeutics. Neurosurgery. 1981;8(1):112-117. doi: 10.1227/00006123-198101000-00022. Go to original source... Go to PubMed...
    18. Orlandi N, Bartolini E, Audenino D, et al. Intravenous brivaracetam in status epilepticus: A multicentric retrospective study in Italy. Seizure - European Journal of Epilepsy. 2021;86:70-76. doi: 10.1016/j.seizure.2021.01.014. Go to original source... Go to PubMed...
    19. Sennesael AL, et al. The Impact of Strong Inducers on Direct Oral Anticoagulant Levels. The American Journal of Medicine. 2021;134(10):1295-1299. doi: 10.1016/j.amjmed.2021.06.003. Go to original source... Go to PubMed...
    20. Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):512-521. doi: 10.1111/epi.13709. Go to original source... Go to PubMed...
    21. Strzelczyk A, Zöllner JP, Willems LM, et al. Lacosamide in status epilepticus: Systematic review of current evidence. 2017;58(6):933-950. doi: 10.1111/epi.13716. Go to original source...
    22. Sztajnkrycer MD. Valproic acid toxicity: overview and management. Journal of Toxicology. Clinical Toxicology. 2002;40(6):789-801. doi: 10.1081/clt-120014645. Go to original source... Go to PubMed...
    23. Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus - report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56(10):1515-1523. doi: 10.1111/epi.13121. Go to original source... Go to PubMed...

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