Treatment of Status Epilepticus: An International Survey of Experts

Abstract

Background  

As part of the development of the Neurocritical Care Society (NCS) Status Epilepticus (SE) Guidelines, the NCS SE Writing Committee conducted an international survey of SE experts.

Methods  

The survey consisted of three patient vignettes (case 1, an adult; case 2, an adolescent; case 3, a child) and questions regarding treatment. The questions for each case focused on initial and sequential therapy as well as when to use continuous intravenous (cIV) therapy and for what duration. Responses were obtained from 60/120 (50%) of those surveyed.

Results  

This survey reveals that there is expert consensus for using intravenous lorazepam for the emergent (first-line) therapy of SE in children and adults. For urgent (second-line) therapy, the most common agents chosen were phenytoin/fosphenytoin, valproate sodium, and levetiracetam; these choices varied by the patient age in the case scenarios. Physicians who care for adult patients chose cIV therapy for RSE, especially midazolam and propofol, rather than a standard AED sooner than those who care for children; and in children, there is a reluctance to choose propofol. Pentobarbital was chosen later in the therapy for all ages.

Conclusion  

There is close agreement between the recently published NCS guideline for SE and this survey of experts in the treatment of SE.

• Content Type Journal Article
• Category Original Article
• Pages 1-8
• DOI 10.1007/s12028-012-9790-1
• Authors
  • James J. Riviello Jr., NYU Comprehensive Epilepsy Center, NYU Langone Medical Center, Division of Pediatric Neurology, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA
  • Jan Claassen, Columbia University, New York, NY, USA
  • Suzette M. LaRoche, Emory University, Altanta, GA, USA
  • Michael R. Sperling, Thomas Jefferson University, Philadelphia, PA, USA
  • Brian Alldredge, University of California, San Francisco, CA, USA
  • Thomas P. Bleck, Rush University Medical Center, Chicago, IL, USA
  • Tracy Glauser, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
  • Lori Shutter, University of Cincinnati Medical Center, Cincinnati, OH, USA
  • David M. Treiman, Arizona State University, Tempe, AZ, USA
  • Paul M. Vespa, University of California, Los Angeles, CA, USA
  • Rodney Bell, Thomas Jefferson University, Philadelphia, PA, USA
  • Gretchen M. Brophy, Virginia Commonwealth University, Richmond, VA, USA
  • The Neurocritical Care Society Status Epilepticus Guideline Writing Committee

• Journal Neurocritical Care
• Online ISSN 1556-0961
• Print ISSN 1541-6933

http://www.springerlink.com/content/1772508664137120/

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