The anaesthetic and intensive care of status epilepticus.

Abstract:

PURPOSE OF REVIEW:Status epilepticus refractory to first and second-line anticonvulsants represents an outstanding challenge to the medical team. This review covers new insights into the anaesthetic and intensive care of status epilepticus. RECENT FINDINGS:In the anaesthetic treatment of status epilepticus, barbiturates, midazolam, or propofol are the drugs of choice, but the lack of controlled prospective data as yet does not allow the recommendation of a preference for one of the substances, unequivocally. Recent observational studies reported on inhalational anaesthetics and supplementary nonanaesthetics such as levetiracetam or topiramate that may be administered if status epilepticus is not controlled by intravenous anaesthetics. Nonpharmacological approaches including resective surgery, brain stimulation, and hypothermia may be applied in selected patients, only. Psychogenic nonepileptic status epilepticus commonly mimics refractory generalized convulsive status epilepticus, and clinical features discerning the two conditions are presented. The underlying cause is the major contributor for a difficult-to-treat 'malignant' course of status epilepticus and together with age determines mortality and functional outcome. SUMMARY:The common substances administered for the anaesthetic treatment of status epilepticus require assessment in a prospective randomized controlled trial. Alternative pharmacological or nonpharmacological approaches need further studies as well before they can be recommended as part of the therapeutic regime.

journal_name

Curr Opin Neurol

authors

Holtkamp M

doi

10.1097/WCO.0b013e328042bacb

subject

Has Abstract

pub_date

2007-04-01 00:00:00

pages

188-93

issue

2

eissn

1350-7540

issn

1473-6551

pii

00019052-200704000-00012

journal_volume

20

pub_type

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