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J Neurol Sci. 2003 Jul 15;211(1-2):37-41.

Treatment of status epilepticus: a survey of neurologists.

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1
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.

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.

PMID:
12767495
[Indexed for MEDLINE]
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