Recommend Documents. Status Epileptikus. Status epileptikus. Status Epileptikus. Abstract Non convulsive status epilepticus (NCSE) is defined as mental status changes from baseline of at least 30 minutes duration association with continuous ictal discharge of EEG. Diagnosa dan penatalaksanaan status.

Abstract

During the past two decades, substantial progress has been made in the understanding of the clinical features, classification, pathophysiology, central nervous system consequences, and treatment of status epilepticus. The most commonly used drug regimens have advantages and disadvantages, and, in this review, I recommend a protocol for the treatment of status epilepticus. An important concept in the approach to patients in generalized tonic-clonic status epilepticus is that treatment should be administered within a predetermined time frame. Clinical and experimental research indicates that continuous seizure activity for longer than 60 to 90 minutes may result in irreversible brain damage. As our understanding of the basic mechanisms of neuronal function and seizure generation advances, it is expected that more specific and novel approaches to the treatment of status epilepticus will emerge.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

These references are in PubMed. This may not be the complete list of references from this article.

Status Epilepticus Guidelines

• Hauser WA. Status epilepticus: epidemiologic considerations. Neurology. 1990 May;40(5 Suppl 2):9–13. [PubMed] [Google Scholar]
• Leppik IE. Status epilepticus: the next decade. Neurology. 1990 May;40(5 Suppl 2):4–9. [PubMed] [Google Scholar]
• Hauser WA. Status epilepticus: frequency, etiology, and neurological sequelae. Adv Neurol. 1983;34:3–14. [PubMed] [Google Scholar]
• Aminoff MJ, Simon RP. Status epilepticus. Causes, clinical features and consequences in 98 patients. Am J Med. 1980 Nov;69(5):657–666. [PubMed] [Google Scholar]
• Meldrum BS, Brierley JB. Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. Arch Neurol. 1973 Jan;28(1):10–17. [PubMed] [Google Scholar]
• Meldrum BS, Vigouroux RA, Brierley JB. Systemic factors and epileptic brain damage. Prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol. 1973 Aug;29(2):82–87. [PubMed] [Google Scholar]
• Meldrum BS. Metabolic factors during prolonged seizures and their relation to nerve cell death. Adv Neurol. 1983;34:261–275. [PubMed] [Google Scholar]
• Knopman D, Margolis G, Reeves AG. Prolonged focal epilepsy and hypoxemia as a cause of focal brain damage: a case study. Ann Neurol. 1977 Feb;1(2):195–198. [PubMed] [Google Scholar]
• Engel J, Jr, Ludwig BI, Fetell M. Prolonged partial complex status epilepticus: EEG and behavioral observations. Neurology. 1978 Sep;28(9 Pt 1):863–869. [PubMed] [Google Scholar]
• Treiman DM, Delgado-Escueta AV. Complex partial status epilepticus. Adv Neurol. 1983;34:69–81. [PubMed] [Google Scholar]
• Falconer MA. Genetic and related aetiological factors in temporal lobe epilepsy. A review. Epilepsia. 1971 Mar;12(1):13–31. [PubMed] [Google Scholar]
• Falconer MA. Mesial temporal (Ammon's horn) sclerosis as a common cause of epilepsy. Aetiology, treatment, and prevention. Lancet. 1974 Sep 28;2(7883):767–770. [PubMed] [Google Scholar]
• Duncan JS, Sagar HJ. Seizure characteristics, pathology, and outcome after temporal lobectomy. Neurology. 1987 Mar;37(3):405–409. [PubMed] [Google Scholar]
• Meldrum BS, Horton RW. Physiology of status epilepticus in primates. Arch Neurol. 1973 Jan;28(1):1–9. [PubMed] [Google Scholar]
• Meldrum BS, Horton RW, Bloom SR, Butler J, Keenan J. Endocrine factors and glucose metabolism during prolonged seizures in baboons. Epilepsia. 1979 Oct;20(5):527–533. [PubMed] [Google Scholar]
• Simon RP, Bayne LL, Tranbaugh RF, Lewis FR. Elevated pulmonary lymph flow and protein content during status epilepticus in sheep. J Appl Physiol Respir Environ Exerc Physiol. 1982 Jan;52(1):91–95. [PubMed] [Google Scholar]
• Simon RP, Aminoff MJ, Benowitz NL. Changes in plasma catecholamines after tonic-clonic seizures. Neurology. 1984 Feb;34(2):255–257. [PubMed] [Google Scholar]
• Simon RP. Physiologic consequences of status epilepticus. Epilepsia. 1985;26 (Suppl 1):S58–S66. [PubMed] [Google Scholar]
• Delgado-Escueta AV, Wasterlain C, Treiman DM, Porter RJ. Status epilepticus: summary. Adv Neurol. 1983;34:537–541. [PubMed] [Google Scholar]
• Lothman E. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990 May;40(5 Suppl 2):13–23. [PubMed] [Google Scholar]
• Walton NY, Treiman DM. Response of status epilepticus induced by lithium and pilocarpine to treatment with diazepam. Exp Neurol. 1988 Aug;101(2):267–275. [PubMed] [Google Scholar]
• Treiman DM, Walton NY, Kendrick C. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res. 1990 Jan-Feb;5(1):49–60. [PubMed] [Google Scholar]
• Treiman DM. The role of benzodiazepines in the management of status epilepticus. Neurology. 1990 May;40(5 Suppl 2):32–42. [PubMed] [Google Scholar]
• Lothman EW, Bertram EH, Bekenstein JW, Perlin JB. Self-sustaining limbic status epilepticus induced by 'continuous' hippocampal stimulation: electrographic and behavioral characteristics. Epilepsy Res. 1989 Mar-Apr;3(2):107–119. [PubMed] [Google Scholar]
• Menini C, Meldrum BS, Riche D, Silva-Comte C, Stutzmann JM. Sustained limbic seizures induced by intraamygdaloid kainic acid in the baboon: Symptomatology and neuropathological consequences. Ann Neurol. 1980 Nov;8(5):501–509. [PubMed] [Google Scholar]
• Ben-Ari Y, Tremblay E, Ottersen OP, Naquet R. Evidence suggesting secondary epileptogenic lesion after kainic acid: pre treatment with diazepam reduces distant but not local brain damage. Brain Res. 1979 Apr 13;165(2):362–365. [PubMed] [Google Scholar]
• Ben-Ari Y, Tremblay E, Ottersen OP, Meldrum BS. The role of epileptic activity in hippocampal and 'remote' cerebral lesions induced by kainic acid. Brain Res. 1980 Jun 2;191(1):79–97. [PubMed] [Google Scholar]
• Ben-Ari Y, Tremblay E, Ottersen OP. Injections of kainic acid into the amygdaloid complex of the rat: an electrographic, clinical and histological study in relation to the pathology of epilepsy. Neuroscience. 1980;5(3):515–528. [PubMed] [Google Scholar]
• Lothman EW, Collins RC. Kainic acid induced limbic seizures: metabolic, behavioral, electroencephalographic and neuropathological correlates. Brain Res. 1981 Aug 10;218(1-2):299–318. [PubMed] [Google Scholar]
• Nadler JV. Minireview. Kainic acid as a tool for the study of temporal lobe epilepsy. Life Sci. 1981 Nov 16;29(20):2031–2042. [PubMed] [Google Scholar]
• Collins RC, Lothman EW, Olney JW. Status epilepticus in the limbic system: biochemical and pathological changes. Adv Neurol. 1983;34:277–288. [PubMed] [Google Scholar]
• Sloviter RS. 'Epileptic' brain damage in rats induced by sustained electrical stimulation of the perforant path. I. Acute electrophysiological and light microscopic studies. Brain Res Bull. 1983 May;10(5):675–697. [PubMed] [Google Scholar]
• Olney JW, deGubareff T, Sloviter RS. 'Epileptic' brain damage in rats induced by sustained electrical stimulation of the perforant path. II. Ultrastructural analysis of acute hippocampal pathology. Brain Res Bull. 1983 May;10(5):699–712. [PubMed] [Google Scholar]
• Bertram EH, Lothman EW, Lenn NJ. The hippocampus in experimental chronic epilepsy: a morphometric analysis. Ann Neurol. 1990 Jan;27(1):43–48. [PubMed] [Google Scholar]
• Pisa M, Sanberg PR, Corcoran ME, Fibiger HC. Spontaneously recurrent seizures after intracerebral injections of kainic acid in rat: a possible model of human temporal lobe epilepsy. Brain Res. 1980 Nov 3;200(2):481–487. [PubMed] [Google Scholar]
• Lothman EW, Bertram EH, Kapur J, Stringer JL. Recurrent spontaneous hippocampal seizures in the rat as a chronic sequela to limbic status epilepticus. Epilepsy Res. 1990 Jul;6(2):110–118. [PubMed] [Google Scholar]
• Sloviter RS. Calcium-binding protein (calbindin-D28k) and parvalbumin immunocytochemistry: localization in the rat hippocampus with specific reference to the selective vulnerability of hippocampal neurons to seizure activity. J Comp Neurol. 1989 Feb 8;280(2):183–196. [PubMed] [Google Scholar]
• Leppik IE, Derivan AT, Homan RW, Walker J, Ramsay RE, Patrick B. Double-blind study of lorazepam and diazepam in status epilepticus. JAMA. 1983 Mar 18;249(11):1452–1454. [PubMed] [Google Scholar]
• Bear DM. Temporal lobe epilepsy and the Bear-Fedio personality inventory. Neurology. 1985 Feb;35(2):284–286. [PubMed] [Google Scholar]
• Shaner DM, McCurdy SA, Herring MO, Gabor AJ. Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology. 1988 Feb;38(2):202–207. [PubMed] [Google Scholar]
• Wilder BJ, Ramsay RE, Willmore LJ, Feussner GF, Perchalski RJ, Shumate JB., Jr Efficacy of intravenous phenytoin in the treatment of status epilepticus: kinetics of central nervous system penetration. Ann Neurol. 1977 Jun;1(6):511–518. [PubMed] [Google Scholar]
• Cranford RE, Leppik IE, Patrick B, Anderson CB, Kostick B. Intravenous phenytoin: clinical and pharmacokinetic aspects. Neurology. 1978 Sep;28(9 Pt 1):874–880. [PubMed] [Google Scholar]
• Cranford RE, Leppik IE, Patrick B, Anderson CB, Kostick B. Intravenous phenytoin in acute treatment of seizures. Neurology. 1979 Nov;29(11):1474–1479. [PubMed] [Google Scholar]
• Earnest MP, Marx JA, Drury LR. Complications of intravenous phenytoin for acute treatment of seizures. Recommendations for usage. JAMA. 1983 Feb 11;249(6):762–765. [PubMed] [Google Scholar]
• Ramsay RE. Pharmacokinetics and clinical use of parenteral phenytoin, phenobarbital, and paraldehyde. Epilepsia. 1989;30 (Suppl 2):S1–S3. [PubMed] [Google Scholar]
• Ramsay RE, Hammond EJ, Perchalski RJ, Wilder BJ. Brain uptake of phenytoin, phenobarbital, and diazepam. Arch Neurol. 1979 Sep;36(9):535–539. [PubMed] [Google Scholar]
• Treiman DM. Pharmacokinetics and clinical use of benzodiazepines in the management of status epilepticus. Epilepsia. 1989;30 (Suppl 2):S4–10. [PubMed] [Google Scholar]
• Walton NY, Treiman DM. Lorazepam treatment of experimental status epilepticus in the rat: relevance to clinical practice. Neurology. 1990 Jun;40(6):990–994. [PubMed] [Google Scholar]
• Prensky AL, Raff MC, Moore MJ, Schwab RS. Intravenous diazepam in the treatment of prolonged seizure activity. N Engl J Med. 1967 Apr 6;276(14):779–784. [PubMed] [Google Scholar]
• Lalji D, Hosking CS, Sutherland JM. Diazepam ('Valium') in the control of status epilepticus. Med J Aust. 1967 Mar 18;1(11):542–545. [PubMed] [Google Scholar]
• Sawyer GT, Webster DD, Schut LJ. Treatment of uncontrolled seizure activity with diazepam. JAMA. 1968 Mar 11;203(11):913–918. [PubMed] [Google Scholar]
• Bell DS. Dangers of treatment of status epilepticus with diazepam. Br Med J. 1969 Jan 18;1(5637):159–161.[PMC free article] [PubMed] [Google Scholar]
• Greenblatt DJ, Koch-Weser J. Adverse reactions to intravenous diazepam: a report from the Boston Collaborative Drug Surveillance Program. Am J Med Sci. 1973 Oct;266(4):261–266. [PubMed] [Google Scholar]
• Brauninger G, Ravin M. Respiratory arrest following intravenous Valium. Ann Ophthalmol. 1974 Aug;6(8):805–806. [PubMed] [Google Scholar]
• Uthman BM, Wilder BJ. Emergency management of seizures: an overview. Epilepsia. 1989;30 (Suppl 2):S33–S37. [PubMed] [Google Scholar]
• Young GB, Blume WT, Bolton CF, Warren KG. Anesthetic barbiturates in refractory status epilepticus. Can J Neurol Sci. 1980 Nov;7(4):291–292. [PubMed] [Google Scholar]
• Young RS, Ropper AH, Hawkes D, Woods M, Yohn P. Pentobarbital in refractory status epilepticus. Pediatr Pharmacol (New York) 1983;3(2):63–67. [PubMed] [Google Scholar]
• Orlowski JP, Erenberg G, Lueders H, Cruse RP. Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med. 1984 Apr;12(4):367–372. [PubMed] [Google Scholar]
• Rashkin MC, Youngs C, Penovich P. Pentobarbital treatment of refractory status epilepticus. Neurology. 1987 Mar;37(3):500–503. [PubMed] [Google Scholar]
• Lowenstein DH, Aminoff MJ, Simon RP. Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. Neurology. 1988 Mar;38(3):395–400. [PubMed] [Google Scholar]
• Van Ness PC. Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin. Epilepsia. 1990 Jan-Feb;31(1):61–67. [PubMed] [Google Scholar]
• Meldrum B. Amino acid neurotransmitters and new approaches to anticonvulsant drug action. Epilepsia. 1984;25 (Suppl 2):S140–S149. [PubMed] [Google Scholar]
• Leppik IE, Boucher R, Wilder BJ, Murthy VS, Rask CA, Watridge C, Graves NM, Rangel RJ, Turlapaty P. Phenytoin prodrug: preclinical and clinical studies. Epilepsia. 1989;30 (Suppl 2):S22–S26. [PubMed] [Google Scholar]
• Leppik IE, Boucher BA, Wilder BJ, Murthy VS, Watridge C, Graves NM, Rangel RJ, Rask CA, Turlapaty P. Pharmacokinetics and safety of a phenytoin prodrug given i.v. or i.m. in patients. Neurology. 1990 Mar;40(3 Pt 1):456–460. [PubMed] [Google Scholar]

Associated Data

Supplementary Materials

Status Epilepticus