Journal
JOURNAL OF THE NEUROLOGICAL SCIENCES
Volume 211, Issue 1-2, Pages 37-41Publisher
ELSEVIER
DOI: 10.1016/S0022-510X(03)00036-4
Keywords
epilepsy/EEG; status epilepticus; survey
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Background: New antiepileptic drugs (AEDs) have provided alternatives to traditional treatment paradigms for status epilepticus (SE). Methods: To deter-mine current treatment preferences for generalized convulsive status epilepticus (GCSE), we surveyed 106 members of the Critical Care or Epilepsy sections of the American Academy of Neurology. Results: Most respondents initially treat patients with intravenous (IV) lorazepam (76%), followed by phenytoin or fosphenytoin (95%) if first-line therapy fails. Preferences for GCSE refractory to two AEDs (RSE) varied: 43% would give phenobarbital, 19% would give one of three continuous-infusion (cIV) AEDs (pentobarbital, midazolam, propofol), and 16% would give IV valproic acid. About half indicated burst suppression (56%) and half indicated elimination of seizures (41%) as the titration goal for cIV-AED therapy. About half (42%) would add a new cIV-AED, and the other half (41%) would not add another agent to treat electrographic SE refractory to four AEDs. Discussion: In accordance with published trials and general guidelines, neurologists most often use lorazepam followed by phenytoin or fosphenytoin as first-line and second-line therapies for GCSE. There is no consensus for third-line or fourth-line treatment for RSE. The treatment of RSE needs to be studied in a large, prospective, randomized, multicenter trial. (C) 2003 Elsevier Science B.V. All rights reserved.
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