A patient in status epilepticus has continuous or rapidly repeatingseizures. Although the danger of this pattern of seizure activityhas been recognized since antiquity, our understanding of thepathophysiology of status epilepticus is incomplete. The frequencyof cases in the United States is approximately 102,000 to 152,000per year, and roughly 55,000 deaths are associated with statusepilepticus annually.1 Twelve to 30 percent of adult patientswith a new diagnosis of epilepsy first present in status epilepticus.2,3This review focuses on generalized status epilepticus, whichis the most common form of the disorder.1,4 This is a life-threateningcondition that . . . [Full Text of this Article]
Definitions
Clinical Features of Generalized Status Epilepticus
Outcomes and Causes of Status Epilepticus
Pathophysiology
Management
Principles of Drug Treatment
Pharmacologic Therapy
Benzodiazepines
Phenytoin and Fosphenytoin
Phenobarbital
Other Therapies
Treatment of Refractory Status Epilepticus
Out-of-Hospital Treatment
Source Information
From the Departments of Neurology (D.H.L., B.K.A.) and Anatomy (D.H.L.), School of Medicine, and the Department of Clinical Pharmacy, School of Pharmacy (B.K.A.), University of California, San Francisco.
Address reprint requests to Dr. Lowenstein at the Department of Neurology, Box 0114, UCSF School of Medicine, 505 Parnassus Ave., San Francisco, CA 94143-0114.
References
Related Letters:
Status Epilepticus
Groba C. B., Walls R. M., Sagarin M. J., Nelson L. S., Rella J., Hoffman R. S., Traynor B. J., Hardiman O., Lowenstein D. H., Alldredge B. K.
Extract |
Full Text
N Engl J Med 1998;
339:409-410, Aug 6, 1998.
Correspondence
This article has been cited by other articles:
Sofou, K., Kristjansdottir, R., Papachatzakis, N. E., Ahmadzadeh, A., Uvebrant, P.
(2009). Management of Prolonged Seizures and Status Epilepticus in Childhood: A Systematic Review. J Child Neurol
24: 918-926
[Abstract]
Moddel, G, Bunten, S, Dobis, C, Kovac, S, Dogan, M, Fischera, M, Dziewas, R, Schabitz, W-R, Evers, S, Happe, S
(2009). Intravenous levetiracetam: a new treatment alternative for refractory status epilepticus. J. Neurol. Neurosurg. Psychiatry
80: 689-692
[Abstract][Full Text]
Behrouz, R., Chen, S., Tatum, W. O. IV
(2009). Evaluation and Management of Status Epilepticus in the Neurological Intensive Care Unit. JAOA: Journal of the American Osteopathic Association
109: 237-245
[Abstract][Full Text]
Lehmkuhle, M. J., Thomson, K. E., Scheerlinck, P., Pouliot, W., Greger, B., Dudek, F. E.
(2009). A Simple Quantitative Method for Analyzing Electrographic Status Epilepticus in Rats. J. Neurophysiol.
101: 1660-1670
[Abstract][Full Text]
Miller, M. A, Forni, A., Yogaratnam, D.
(2008). Propylene Glycol-Induced Lactic Acidosis in a Patient Receiving Continuous Infusion Pentobarbital. The Annals of Pharmacotherapy
42: 1502-1506
[Abstract][Full Text]
(2008). EMQ answers. Emerg. Med. J.
25: 542-542
[Full Text]
Rosenow, F., Knake, S.
(2008). Review: Recent and future advances in the treatment of status epilepticus. Therapeutic Advances in Neurological Disorders
1: 25-32
[Abstract]
Terunuma, M., Xu, J., Vithlani, M., Sieghart, W., Kittler, J., Pangalos, M., Haydon, P. G., Coulter, D. A., Moss, S. J.
(2008). Deficits in Phosphorylation of GABAA Receptors by Intimately Associated Protein Kinase C Activity Underlie Compromised Synaptic Inhibition during Status Epilepticus. J. Neurosci.
28: 376-384
[Abstract][Full Text]
Mehta, V., Singhi, P., Singhi, S.
(2007). Intravenous Sodium Valproate Versus Diazepam Infusion for the Control of Refractory Status Epilepticus in Children: A Randomized Controlled Trial. J Child Neurol
22: 1191-1197
[Abstract]
Cloyd, J.
(2007). Pharmacologic Considerations in the Treatment of Repetitive or Prolonged Seizures. J Child Neurol
22: 47S-52S
[Abstract]
Chung, S. S., Wang, N. C., Treiman, D. M.
(2007). Comparative Efficacy and Safety of Antiepileptic Drugs for the Treatment of Status Epilepticus. Journal of Pharmacy Practice
20: 137-146
[Abstract]
Sandstrom, S. A., Anschel, D. J., Chen, D. K., So, Y. T., Fisher, R. S.
(2006). Use of serum prolactin in diagnosing epileptic seizures: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology
67: 544-545
[Full Text]
Rossetti, A O, Hurwitz, S, Logroscino, G, Bromfield, E B
(2006). Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation. J. Neurol. Neurosurg. Psychiatry
77: 611-615
[Abstract][Full Text]
Goodkin, H. P., Yeh, J.-L., Kapur, J.
(2005). Status Epilepticus Increases the Intracellular Accumulation of GABAA Receptors. J. Neurosci.
25: 5511-5520
[Abstract][Full Text]
Holtkamp, M, Othman, J, Buchheim, K, Meierkord, H
(2005). Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J. Neurol. Neurosurg. Psychiatry
76: 534-539
[Abstract][Full Text]
Limdi, N. A., Shimpi, A. V., Faught, E., Gomez, C. R., Burneo, J. G.
(2005). Efficacy of rapid IV administration of valproic acid for status epilepticus. Neurology
64: 353-355
[Abstract][Full Text]
Wheless, J. W., Vazquez, B. R., Kanner, A. M., Ramsay, R. E., Morton, L., Pellock, J. M.
(2004). Rapid infusion with valproate sodium is well tolerated in patients with epilepsy. Neurology
63: 1507-1508
[Abstract][Full Text]
Marik, P. E., Varon, J.
(2004). The Management of Status Epilepticus. Chest
126: 582-591
[Abstract][Full Text]
Mirsattari, S. M., Sharpe, M. D., Young, G. B.
(2004). Treatment of Refractory Status Epilepticus With Inhalational Anesthetic Agents Isoflurane and Desflurane. Arch Neurol
61: 1254-1259
[Abstract][Full Text]
Howard, R. S, Kullmann, D. M, Hirsch, N. P
(2003). Admission to neurological intensive care: who, when, and why?. J. Neurol. Neurosurg. Psychiatry
74: iii2-9
[Full Text]
Devi, G., Castro, V. J., Huitink, J., Buitelaar, D., Kosten, T., O'Connor, P.
(2003). Management of Drug and Alcohol Withdrawal. NEJM
349: 405-407
[Full Text]
Manno, E. M.
(2003). New Management Strategies in the Treatment of Status Epilepticus. Mayo Clin Proc.
78: 508-518
[Abstract]
Schmoll, H., Badan, I., Grecksch, G., Walker, L., Kessler, C., Popa-Wagner, A.
(2003). Kindling Status in Sprague-Dawley Rats Induced by Pentylenetetrazole: Involvement of a Critical Development Period. Am. J. Pathol.
162: 1027-1034
[Abstract][Full Text]
Faverjon, S., Silveira, D. C., Fu, D. D., Cha, B. H., Akman, C., Hu, Y., Holmes, G. L.
(2002). Beneficial effects of enriched environment following status epilepticus in immature rats. Neurology
59: 1356-1364
[Abstract][Full Text]
Wu, Y. W., Shek, D. W., Garcia, P. A., Zhao, S., Johnston, S. C.
(2002). Incidence and mortality of generalized convulsive status epilepticus in California. Neurology
58: 1070-1076
[Abstract][Full Text]
Lockey, A S
(2002). Emergency department drug therapy for status epilepticus in adults.. Emerg. Med. J.
19: 96-100
[Abstract][Full Text]
Singhi, S., Murthy, A., Singhi, P., Jayashree, M.
(2002). Continuous Midazolam Versus Diazepam Infusion for Refractory Convulsive Status Epilepticus. J Child Neurol
17: 106-110
[Abstract]
Mayer, S. A., Claassen, J., Lokin, J., Mendelsohn, F., Dennis, L. J., Fitzsimmons, B.-F.
(2002). Refractory Status Epilepticus: Frequency, Risk Factors, and Impact on Outcome. Arch Neurol
59: 205-210
[Abstract][Full Text]
Knopp, R. K., Su, M., Chodosh, A., Nelson, L. S., Alldredge, B. K., Lowenstein, D. H.
(2001). Treatment of Out-of-Hospital Status Epilepticus. NEJM
345: 1913-1914
[Full Text]
Graham, C A, Gordon, M W G
(2001). Status epilepticus in accident and emergency: a difficult case. Emerg. Med. J.
18: 492-493
[Full Text]
Claassen, J., Hirsch, L. J., Emerson, R. G., Bates, J. E., Thompson, T. B., Mayer, S. A.
(2001). Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology
57: 1036-1042
[Abstract][Full Text]
Alldredge, B. K., Gelb, A. M., Isaacs, S. M., Corry, M. D., Allen, F., Ulrich, S., Gottwald, M. D., O'Neil, N., Neuhaus, J. M., Segal, M. R., Lowenstein, D. H.
(2001). A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus. NEJM
345: 631-637
[Abstract][Full Text]
Browne, T. R., Holmes, G. L.
(2001). Epilepsy. NEJM
344: 1145-1151
[Full Text]
Ng, Y.-t., Cox, C., Atkins, J., Butler, I. J.
(2001). Encephalopathy Associated With Respiratory Syncytial Virus Bronchiolitis. J Child Neurol
16: 105-108
[Abstract]
Gordon, I.J., Nisbet, H.I.A., Jones, E.S.
(2000). Status epilepticus treated with a muscle relaxant: the first success. QJM
93: 837-838
[Abstract][Full Text]
Heafield, M T E
(2000). Managing status epilepticus. BMJ
320: 953-954
[Full Text]
Sheth, R. D., Gidal, B. E.
(2000). Intravenous valproic acid for myoclonic status epilepticus. Neurology
54: 1201-1201
[Full Text]
Meek, P. D., Davis, S. N., Collins, D. M., Gidal, B. E., Rutecki, P. A., Burstein, A. H., Fischer, J. H., Leppik, I. E., Ramsay, R. E., for the Panel on Nonemergency Use of Parenteral Ph,
(1999). Guidelines for Nonemergency Use of Parenteral Phenytoin Products: Proceedings of an Expert Panel Consensus Process. Arch Intern Med
159: 2639-2644
[Abstract][Full Text]
Gilbert, D. L., Glauser, T. A.
(1999). Complications and Costs of Treatment of Refractory Generalized Convulsive Status Epilepticus in Children. J Child Neurol
14: 597-601
[Abstract]
Gilbert, D. L., Gartside, P. S., Glauser, T. A.
(1999). Efficacy and Mortality in Treatment of Refractory Generalized Convulsive Status Epilepticus in Children: A Meta-Analysis. J Child Neurol
14: 602-609
[Abstract]
Groba, C. B., Walls, R. M., Sagarin, M. J., Nelson, L. S., Rella, J., Hoffman, R. S., Traynor, B. J., Hardiman, O., Lowenstein, D. H., Alldredge, B. K.
(1998). Status Epilepticus. NEJM
339: 409-410
[Full Text]