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. 2024 Jun;65(6):1512-1530.
doi: 10.1111/epi.17982. Epub 2024 Apr 12.

Clinical practice guidelines on the management of status epilepticus in adults: A systematic review

Luca Vignatelli  1 , Valentina Tontini  1 , Stefano Meletti  2 , Maria Camerlingo  3 , Stefania Mazzoni  1 , Giada Giovannini  2 , Elena Pasini  1 , Roberto Michelucci  1 , Francesca Bisulli  1   4 , Paolo Tinuper  4 , Lidia Di Vito  1
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Clinical practice guidelines on the management of status epilepticus in adults: A systematic review

Luca Vignatelli et al. Epilepsia. 2024 Jun.

Abstract

Objective: Status epilepticus (SE) is the second most common neurological emergency in adults. Despite improvements in the management of acute neurological conditions over the last decade, mortality is still durably high. Because a gap has emerged between SE management based on clinical practice guidelines (CPGs) and actual clinical practice, we conducted a systematic review of CPGs, assessing their quality, outlining commonalities and discrepancies in recommendations, and highlighting research gaps.

Methods: We searched the PubMed and EMBASE databases and other gray literature sources (nine among guideline registries, evidence-based medicine databases, point-of-care tools; seven websites of governmental organizations and international neurologic societies) in December 2021 (updated in November 2023). The units of analysis were CPGs that included recommendations on the diagnostic and/or therapeutic management of SE in adults. The quality of the CPGs was assessed using the AGREE II tool.

Results: Fifteen CPGs were included. The "Applicability" domain was assigned the lowest median score of 10%. The domains "Stakeholder Involvement", "Rigor of Development," and "Editorial Independence" were as well generally underrated. Recommendations on general and diagnostic management and on organizational interventions were fragmented and scattered. Recommendations on pre-hospital and hospital treatment of early-onset and refractory SE were broadly agreed, whereas there was less agreement on the treatment model and medications for established SE and super-refractory SE.

Significance: The CPGs for the management of SE developed in recent years are flawed by several methodological issues and discrepancies in the coverage of important topics. The gap between CPG-based management of SE and actual clinical practice may be due in part to the inherent limitations of the CPGs produced so far.

Keywords: anticonvulsants; electroencephalography; guideline adherence; practice guidelines as topic; status epilepticus.

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References

REFERENCES

    1. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus–Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56:1515–1523.
    1. Legriel S, Azoulay E, Resche‐Rigon M, Lemiale V, Mourvillier B, Kouatchet A, et al. Functional outcome after convulsive status epilepticus. Crit Care Med. 2010;38:2295–2303.
    1. Neligan A, Noyce AJ, Gosavi TD, Shorvon SD, Köhler S, Walker MC. Change in mortality of generalized convulsive status epilepticus in high‐income countries over time: a systematic review and meta‐analysis. JAMA Neurol. 2019;76:897–905.
    1. Leitinger M, Trinka E, Giovannini G, Zimmermann G, Florea C, Rohracher A, et al. Epidemiology of status epilepticus in adults: a population‐based study on incidence, causes, and outcomes. Epilepsia. 2019;60:53–62.
    1. Amengual‐Gual M, Sánchez Fernández I, Wainwright MS. Novel drugs and early polypharmacotherapy in status epilepticus. Seizure. 2019;68:79–88.

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