Treatment of status epilepticus: a survey of neurologists

Claassen, Jan; Hirsch, Lawrence J.; Mayer, Stephan A.

doi:10.1016/S0022-510X(03)00036-4

« Previous Next »Journal of the Neurological Sciences
Volume 211, Issue 1 , Pages 37-41, 15 July 2003

Treatment of status epilepticus: a survey of neurologists

Jan Claassen
- Division of Critical Care Neurology, Department of Neurology, Neurological Institute, Columbia University College of Physicians and Surgeons, 710 West 168th Street, Unit 39, New York, NY 10032, USA
- Comprehensive Epilepsy Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
Lawrence J. Hirsch
- Comprehensive Epilepsy Center, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
Stephan A. Mayer
- Corresponding author. Tel.: +1-212-305-7236; fax: +1-212-305-2792.
- Division of Critical Care Neurology, Department of Neurology, Neurological Institute, Columbia University College of Physicians and Surgeons, 710 West 168th Street, Unit 39, New York, NY 10032, USA

Received 26 August 2002; received in revised form 17 December 2002; accepted 4 February 2003.

Abstract

Background: New antiepileptic drugs (AEDs) have provided alternatives to traditional treatment paradigms for status epilepticus (SE). Methods: To determine current treatment preferences for generalized convulsive status epilepticus (GCSE), we surveyed 106 members of the Critical Care or Epilepsy sections of the American Academy of Neurology. Results: Most respondents initially treat patients with intravenous (IV) lorazepam (76%), followed by phenytoin or fosphenytoin (95%) if first-line therapy fails. Preferences for GCSE refractory to two AEDs (RSE) varied: 43% would give phenobarbital, 19% would give one of three continuous-infusion (cIV) AEDs (pentobarbital, midazolam, propofol), and 16% would give IV valproic acid. About half indicated “burst suppression” (56%) and half indicated “elimination of seizures” (41%) as the titration goal for cIV-AED therapy. About half (42%) would add a new cIV-AED, and the other half (41%) would not add another agent to treat electrographic SE refractory to four AEDs. Discussion: In accordance with published trials and general guidelines, neurologists most often use lorazepam followed by phenytoin or fosphenytoin as first-line and second-line therapies for GCSE. There is no consensus for third-line or fourth-line treatment for RSE. The treatment of RSE needs to be studied in a large, prospective, randomized, multicenter trial.

Keywords: Epilepsy/EEG, Status epilepticus, Survey