open access

Vol 52, No 4 (2018)
Guidelines
Submitted: 2018-03-20
Get Citation

Convulsive status epilepticus management in adults and children: Report of the Working Group of the Polish Society of Epileptology

J. Jędrzejczak, M. Mazurkiewicz-Bełdzińska, M. Szmuda, B. Majkowska-Zwolińska, B. Steinborn, D. Ryglewicz, R. Owczuk, A. Bartkowska-Śniatkowska, E. Widera, K. Rejdak, M. Siemiński, E. Nagańska
DOI: 10.1016/j.pjnns.2018.04.002
·
Neurol Neurochir Pol 2018;52(4):419-426.

open access

Vol 52, No 4 (2018)
Guidelines
Submitted: 2018-03-20

Abstract

Introduction

The Working Group was established at the initiative of the General Board of the Polish Society of Epileptology (PSE) to develop an expert position on the treatment of convulsive status epilepticus (SE) in adults and children in Poland. Generalized convulsive SE is the most common form and also represents the greatest threat to life, highlighting the importance of the choice of appropriate therapeutic treatment.

Aim of guideline

We present the therapeutic options separately for treatment during the early preclinical (>5–30min), established (30–60min), and refractory (>60min) SE phases. This division is based on time and response to AEDs, and indicates a practical approach based on pathophysiological data.

Results

Benzodiazepines (BZD) are the first-line drugs. In cases of ineffective first-line treatment and persistence of the seizure, the use of second-line treatment: phenytoin, valproic acid or phenobarbital is required. SE that persists after the administration of benzodiazepines and phenytoin or another second-line AED at appropriate doses is defined as refractory and drug resistant and requires treatment in the intensive care unit (ICU). EEG monitoring is essential during therapy at this stage. Anesthesia is typically continued for an initial period of 24h followed by a slow reversal and is re-established if seizures recur. Anesthesia is usually administered either to the level of the “burst suppression pattern” or to obtain the “EEG suppression” pattern.

Conclusions

Experts agree that close and early cooperation with a neurologist and anesthetist aiming to reduce the risk of pharmacoresistant cases is an extremely important factor in the treatment of patients with SE. This report has educational, practical and organizational aspects, outlining a standard plan for SE management in Poland that will improve therapeutic efficacy.

Abstract

Introduction

The Working Group was established at the initiative of the General Board of the Polish Society of Epileptology (PSE) to develop an expert position on the treatment of convulsive status epilepticus (SE) in adults and children in Poland. Generalized convulsive SE is the most common form and also represents the greatest threat to life, highlighting the importance of the choice of appropriate therapeutic treatment.

Aim of guideline

We present the therapeutic options separately for treatment during the early preclinical (>5–30min), established (30–60min), and refractory (>60min) SE phases. This division is based on time and response to AEDs, and indicates a practical approach based on pathophysiological data.

Results

Benzodiazepines (BZD) are the first-line drugs. In cases of ineffective first-line treatment and persistence of the seizure, the use of second-line treatment: phenytoin, valproic acid or phenobarbital is required. SE that persists after the administration of benzodiazepines and phenytoin or another second-line AED at appropriate doses is defined as refractory and drug resistant and requires treatment in the intensive care unit (ICU). EEG monitoring is essential during therapy at this stage. Anesthesia is typically continued for an initial period of 24h followed by a slow reversal and is re-established if seizures recur. Anesthesia is usually administered either to the level of the “burst suppression pattern” or to obtain the “EEG suppression” pattern.

Conclusions

Experts agree that close and early cooperation with a neurologist and anesthetist aiming to reduce the risk of pharmacoresistant cases is an extremely important factor in the treatment of patients with SE. This report has educational, practical and organizational aspects, outlining a standard plan for SE management in Poland that will improve therapeutic efficacy.

Get Citation

Keywords

Epilepsy, Generalized status epilepticus, Guidelines, EEG

About this article
Title

Convulsive status epilepticus management in adults and children: Report of the Working Group of the Polish Society of Epileptology

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 52, No 4 (2018)

Pages

419-426

DOI

10.1016/j.pjnns.2018.04.002

Bibliographic record

Neurol Neurochir Pol 2018;52(4):419-426.

Keywords

Epilepsy
Generalized status epilepticus
Guidelines
EEG

Authors

J. Jędrzejczak
M. Mazurkiewicz-Bełdzińska
M. Szmuda
B. Majkowska-Zwolińska
B. Steinborn
D. Ryglewicz
R. Owczuk
A. Bartkowska-Śniatkowska
E. Widera
K. Rejdak
M. Siemiński
E. Nagańska

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl