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The Current Status of Continuous-Seizure Management

By Catherine A. Marco, MD, FACEP, and Richard Kozak, MD, FACEP | on July 7, 2024 | 1 Comment
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Consultation with neurology should be sought to guide therapy. Patients with status epilepticus require hospital admission, often to an intensive care setting.

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ACEP Now: Vol 43 – No 07 – July 2024

Case Conclusion

Following stabilization of airway, breathing, and circulation, antiepileptic therapy is indicated. This patient has already received first-line treatment with a benzodiazepine. Specific antiepileptic therapy should be initiated with another agent, such as fosphenytoin, phenytoin, levetiracetam, or valproic acid. Neurology consultation should be initiated, and the patient should be admitted to the ICU.

Disclaimer

This article is not a comprehensive review of diagnosis and treatment of status epilepticus but an overview of management and future directions. Authoritative sources should be used for diagnostic and treatment decisions.


References

  1. Brophy GM, Bell R, Claassen J, et al. Neurocritical Care Society Status Epilepticus Guideline Writing Committee. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3-23.
  2. Sutter R, Rüegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: Opening Pandora’s box. Neurol Clin Pract. 2012;2(4):275-286.
  3. Zehtabchi S, Abdel Baki SG, Omurtag A, et al. Prevalence of non-convulsive seizure and other electroencephalographic abnormalities in ED patients with altered mental status. Am J Emerg Med. 2013;31(11):1578-1582.
  4. Towne AR, Waterhouse EJ, Boggs JG, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000;54(2):340-345.
  5. Chen JWY, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5(3):246-256.
  6. Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol. 2015;14(6):615-624.
  7. Huff JS, Melnick ER, Tomaszewski CA, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 2014;63(4):437-447.
  8. Gunawardena S, Chikkannaiah M, Stolfi A, et al. Utility of electroencephalogram in the pediatric emergency department. Am J Emerg Med. 2022;54:26-29.
  9. Paliwal P, Wakerley BR, Yeo LLL, et al. Early electroencephalography in patients with emergency room diagnoses of suspected new-onset seizures: diagnostic yield and impact on clinical decision-making. Seizure. 2015;31:22-26.
  10. Rodríguez Quintana JH, Bueno SJ, Zuleta-Motta JL, et al. The Neuroscience Research Group (NeuRos). Utility of routine EEG in emergency department and inpatient service. Neurol Clin Pract. 2021;11(5):e677-e681.
  11. Prud‘hon S, Amiel H, Zanin A, et al. EEG and acute confusional state at the emergency department. Neurophysiol Clin. 2024;54(4):102966.
  12. Froese L, Dian J, Gomez A, et al. Association between processed electroencephalogram-based objectively measured depth of sedation and cerebrovascular response: a systematic scoping overview of the human and animal literature. Front Neurol. 2021;12:692207.
  13. Kamousi B, Karunakaran S, Gururangan K, et al. Monitoring the burden of seizures and highly epileptiform patterns in critical care with a novel machine learning method. Neurocrit Care. 2021;34(3):908-917.
  14. Kozak R, Gururangan K, Dorriz PJ, et al. Point-of-care electroencephalography enables rapid evaluation and management of non-convulsive seizures and status epilepticus in the emergency department. J Am Coll Emerg Physicians Open. 2023;4(4):e13004.
  15. Jindal M, Neligan A, Rajakulendran S. Early and established status epilepticus: the impact of timing of intervention, treatment escalation and dosing on outcome. Seizure. 2023;111:98-102.
  16. Sathe AG, Underwood E, Coles LD, et al. Patterns of benzodiazepine underdosing in the Established Status Epilepticus Treatment Trial. Epilepsia. 2021;62(3):795-806.
  17. Braun KRM, Pham LL, Wall GC, et al. Suboptimal dosing of benzodiazepines and levetiracetam in a cohort of status epilepticus patients and outcomes associated with inadequate dosing. J Pharm Pract. 2023;36(5):1068-1071.
  18. American College of Emergency Physicians. Seizure. April 2024. Accessed June 17, 2024.
  19. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department with Seizures. https://www.acep.org/siteassets/newpdfs/clinical-policies/seizures-2024-final.pdf. April 17, 2024. Accessed 4/30/2024.
  20. Kapur J, Elm J, Chamberlain JM, et al. Randomized trial of three anticonvulsant medications for status 327 epilepticus. N Engl J Med. 2019;381(22):2103-2113.
  21. Chamberlain JM, Kapur J, Shinnar S, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for 330 established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. Lancet. 2020;395(10231):1217-1224.

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Topics: ClinicalCritical CareSeizurestatus epilepticus

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One Response to “The Current Status of Continuous-Seizure Management”

  1. July 30, 2024

    Scott Weiner, MD, MPH Reply

    I appreciate this article, and this is by no means meant to be a personal attack or discrediting the validity of the information contained in the article. I consult for a pharma company and disclose it whenever I speak or write about something related to that work. In this case, the Open Payments website shows that one of the authors has received over $128,000 from Ceribell, a company that makes a POC EEG system (https://openpaymentsdata.cms.gov/physician/803367). I do not discourage this type of consulting, as I believe it is important for knowledgeable physicians to inform device manufacturers and pharma companies, but I respectfully request that ACEPNow include such disclosures within its articles so readers can be aware of potential biases.

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