Antiepileptic Drug Therapy for Status Epilepticus

Abstract

Status epilepticus (SE) is one of the most serious neurologic emergencies. SE is a condition that encompasses a broad range of semiologic subtypes and heterogeneous etiologies. The treatment of SE primarily involves the management of the underlying etiology and the use of antiepileptic drug therapy to rapidly terminate seizure activities. The Drug Committee of the Korean Epilepsy Society performed a review of existing guidelines and literature with the aim of providing practical recommendations for antiepileptic drug therapy. This article is one of a series of review articles by the Drug Committee and it summarizes staged antiepileptic drug therapy for SE. While evidence of good quality supports the use of benzodiazepines as the first-line treatment of SE, such evidence informing the administration of second- or third-line treatments is lacking; hence, the recommendations presented herein concerning the treatment of established and refractory SE are based on case series and expert opinions. The choice of antiepileptic drugs in each stage should consider the characteristics and circumstances of each patient, as well as their estimated benefit and risk to them. In tandem with the antiepileptic drug therapy, careful searching for and treatment of the underlying etiology are required.

Keywords: anesthetics; antiepileptic drugs; benzodiazepines; drug therapy; seizure; status epilepticus.

Fig. 1. Classification scheme for status epilepticus proposed by the International League Against Epilepsy Task Force on classification of status epilepticus. NCSE: nonconvulsive SE, SE: status epilepticus.

Fig. 2. Treatment options for convulsive status epilepticus at different stages. t₁: the onset of abnormally prolonged seizure, t₂: the onset of the long-term consequences. BS: burst-suppression pattern, CI: continuous infusion, DZP: diazepam, EEG: electroencephalography, FPHT: fosphenytoin, IM: intramuscular, IV: intravenous, KET: ketamine, LCM: lacosamide, LEV: levetiracetam, LZP: lorazepam, MDZ: midazolam, PB: phenobarbital, PE: phenytoin sodium equivalent, PHT: phenytoin, PPF: propofol, PTB: pentobarbital, SE: status epilepticus, THP: thiopental, VPA: valproate.