Status epilepticus -a critical review

Status epilepticus (SE) is a major neurological emergency with an incidence of about 20/100,000 and a mortality between 3 and 40% depending on etiology, age, status type and status duration. Especially generalized tonic clonic SE requires immediate, aggressive and effective treatment to stop seizure activity, to prevent neuronal damage and systemic complications and death. Benzodiazepines and phenytoin / fosphenytoin are traditionally used as first-line drugs and are effective in about 60% of all episodes. However, a notable portion of patients remain in SE. For those narcotics and induction of general anesthesia are used as second-line treatment. Therefore, there is a need for more effective first-line treatment options. Recently, valproic acid was approved for the treatment of status epilepticus in some European countries and two of the newer antiepileptic drugs have become available for i.v. use: Levetiracetam (LEV) and lacosamide (LCM) should be evaluated in prospective controlled trials as possible treatment options. Standardized protocols for the management of SE are useful to improve immediate care.

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