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EFNS guideline on the management of status epilepticus in adults

H Meierkord, Paul Boon UGent, B Engelsen, K Gocke, S Shorvon, P Tinuper and M Holtkamp (2010) EUROPEAN JOURNAL OF NEUROLOGY. 17(3). p.348-355
abstract
The objective of the current article was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005 and in the current updated version all pertinent publications from January 2005 to January 2009. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear, we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4-8 mg lorazepam or 10 mg diazepam directly followed by 18 mg/kg phenytoin. If seizures continue more than 10 min after first injection, another 4 mg lorazepam or 10 mg diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of barbiturates, midazolam or propofol; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non-convulsive SE depends on type and cause. Complex partial SE is initially treated in the same manner as GCSE. However, if it turns out to be refractory, further non-anaesthetising i.v. substances such levetiracetam, phenobarbital or valproic acid should be given instead of anaesthetics. In subtle SE, in most patients, i.v. anaesthesia is required.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
EPILEPSY, PHENYTOIN, PROPOFOL, MIDAZOLAM, SEIZURES, RISK-FACTORS, INTRAVENOUS VALPROATE, NONCONVULSIVE STATUS EPILEPTICUS, refractory status epilepticus, subtle status epilepticus, treatment, REFRACTORY STATUS EPILEPTICUS, CONVULSIVE STATUS EPILEPTICUS, generalised convulsive status epilepticus, complex partial status epilepticus
journal title
EUROPEAN JOURNAL OF NEUROLOGY
Eur. J. Neurol.
volume
17
issue
3
pages
348 - 355
Web of Science type
Article
Web of Science id
000274907000009
JCR category
CLINICAL NEUROLOGY
JCR impact factor
3.765 (2010)
JCR rank
38/185 (2010)
JCR quartile
1 (2010)
ISSN
1351-5101
DOI
10.1111/j.1468-1331.2009.02917.x
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
936808
handle
http://hdl.handle.net/1854/LU-936808
date created
2010-04-26 11:42:18
date last changed
2010-04-26 17:28:58
@article{936808,
  abstract     = {The objective of the current article was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005 and in the current updated version all pertinent publications from January 2005 to January 2009. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear, we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4-8 mg lorazepam or 10 mg diazepam directly followed by 18 mg/kg phenytoin. If seizures continue more than 10 min after first injection, another 4 mg lorazepam or 10 mg diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of barbiturates, midazolam or propofol; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non-convulsive SE depends on type and cause. Complex partial SE is initially treated in the same manner as GCSE. However, if it turns out to be refractory, further non-anaesthetising i.v. substances such levetiracetam, phenobarbital or valproic acid should be given instead of anaesthetics. In subtle SE, in most patients, i.v. anaesthesia is required.},
  author       = {Meierkord, H and Boon, Paul and Engelsen, B and Gocke, K and Shorvon, S and Tinuper, P and Holtkamp, M},
  issn         = {1351-5101},
  journal      = {EUROPEAN JOURNAL OF NEUROLOGY},
  keyword      = {EPILEPSY,PHENYTOIN,PROPOFOL,MIDAZOLAM,SEIZURES,RISK-FACTORS,INTRAVENOUS VALPROATE,NONCONVULSIVE STATUS EPILEPTICUS,refractory status epilepticus,subtle status epilepticus,treatment,REFRACTORY STATUS EPILEPTICUS,CONVULSIVE STATUS EPILEPTICUS,generalised convulsive status epilepticus,complex partial status epilepticus},
  language     = {eng},
  number       = {3},
  pages        = {348--355},
  title        = {EFNS guideline on the management of status epilepticus in adults},
  url          = {http://dx.doi.org/10.1111/j.1468-1331.2009.02917.x},
  volume       = {17},
  year         = {2010},
}

Chicago
Meierkord, H, Paul Boon, B Engelsen, K Gocke, S Shorvon, P Tinuper, and M Holtkamp. 2010. “EFNS Guideline on the Management of Status Epilepticus in Adults.” European Journal of Neurology 17 (3): 348–355.
APA
Meierkord, H., Boon, P., Engelsen, B., Gocke, K., Shorvon, S., Tinuper, P., & Holtkamp, M. (2010). EFNS guideline on the management of status epilepticus in adults. EUROPEAN JOURNAL OF NEUROLOGY, 17(3), 348–355.
Vancouver
1.
Meierkord H, Boon P, Engelsen B, Gocke K, Shorvon S, Tinuper P, et al. EFNS guideline on the management of status epilepticus in adults. EUROPEAN JOURNAL OF NEUROLOGY. 2010;17(3):348–55.
MLA
Meierkord, H, Paul Boon, B Engelsen, et al. “EFNS Guideline on the Management of Status Epilepticus in Adults.” EUROPEAN JOURNAL OF NEUROLOGY 17.3 (2010): 348–355. Print.