Acute Seizures and Status Epilepticus


Acute Seizures and Status Epilepticus



© 2018 Elsevier Inc. All rights reserved. Acute repetitive seizures and status epilepticus (SE) are common neurologic emergencies with high morbidity and mortality (Zaccara et al., 2017). Most epileptic seizures are stopped within seconds to minutes by intrinsic seizure terminating mechanisms (Theodore et al., 1994). Individual seizures are usually followed by a refractory period, during which additional seizures do not occur. Failure of the normal seizure terminating mechanisms or the postictal refractory period leads to seizure emergencies. Prolonged or repetitive seizures can lead to neuronal damage and clinical sequelae such as focal neurological deficits, cognitive and motor impairments, and epilepsy. Acute seizure emergencies fall into several subgroups based on the seizure type, duration of seizures, etiology, electroencephalographic patterns, and age.Clinical trials to address acute seizures can have one of several purposes: (1) rapid termination of prolonged or repetitive seizures before SE occurs; (2) termination of established SE; (3) termination of refractory SE (RSE); or (4) amelioration of neuronal damage induced by prolonged seizures (neuroprotection), to prevent long-term sequelae such as cognitive dysfunction and epilepsy (antiepileptogenesis). Recently completed randomized clinical trials (Alldredge et al., 2001; Treiman et al., 1998; Silbergleit et al., 2012) provide some guidelines for aims (1) and (2), but available treatments for seizure emergencies and SE are effective in terminating seizures in only about 60% of patients. Treatment options for patients not responding to initial therapy are controversial. No clinical trials have yet addressed neuroprotection or antiepileptogenesis after acute seizures and SE in humans. This chapter will review the epidemiology, pathophysiology, current management, and trial design methodology for acute prolonged or repetitive seizures and SE.

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Acute repetitive seizures, Antiepileptic drug, Antiseizure drug, Electroencephalograph, Focal status epilepticus, GCSE, Nonconvulsive status epilepticus, Refractory SE, Status epilepticus

Acute Seizures and Status Epilepticus