Department of Neurology, Yeungnam University College of Medicine, Daegu, Korea
ABSTRACT
Status epilepticus (SE) is an under-recognized neurological emergency which requires rapid and aggressive treatment to prevent neuronal damage, systemic complications, and death. The treatment should be started as soon as possible, particularly in generalized convulsive SE, even before arriving hospital by non-medical personnel, and should include general supportive measures, drugs to suppress epileptic activity, and, whenever possible, treatments aimed at relieving the underlying causative condition. The criterion about the duration of SE has been changed to be shorter, from 30 minutes to 5 minutes, to reduce brain injury and increase the successful control of seizures through starting drug treatment at the early stage. The preferred initial treatment pathway of antiepileptic drug is intravenous adminstration of lorazepam or diazepam directly, followed by phenytoin. Refractory SE needs to be treated with anesthetic doses of midazolam, propofol or pentobarbital; the anesthetics are titrated against an electroencephalographic burst-suppression pattern. Standardized treatment guidelines are believed to improve the quality of emergency care and outcomes. Epileptologists must develop local SE treatment guidelines and protocols that define the specialized roles of resident of neurology, nursing staffs and technician, and educate neurological care teams to reenforce and implement the guidelines.
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