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J. Clin. Med. 2016, 5(5), 49; doi:10.3390/jcm5050049

Treatment of Established Status Epilepticus

Department of Neurology, Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA
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Author to whom correspondence should be addressed.
Academic Editors: Gretchen M. Brophy and Paul M. Vespa
Received: 1 February 2016 / Revised: 29 March 2016 / Accepted: 19 April 2016 / Published: 25 April 2016
(This article belongs to the Special Issue Understanding and Treatment of Status Epilepticus)
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Abstract

Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE. View Full-Text
Keywords: status epilepticus; established status epilepticus; treatment; antiseizure; phenytoin; levetiracetam; valproic acid; phenobarbital; lacosamide status epilepticus; established status epilepticus; treatment; antiseizure; phenytoin; levetiracetam; valproic acid; phenobarbital; lacosamide
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Falco-Walter, J.J.; Bleck, T. Treatment of Established Status Epilepticus. J. Clin. Med. 2016, 5, 49.

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