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EFNS guideline on the management of status epilepticus in adults
Article first published online: 30 DEC 2009
© 2009 The Author(s). Journal compilation © 2009 EFNS
European Journal of Neurology
Volume 17, Issue 3, pages 348–355, March 2010
How to Cite
Meierkord, H., Boon, P., Engelsen, B., Göcke, K., Shorvon, S., Tinuper, P. and Holtkamp, M. (2010), EFNS guideline on the management of status epilepticus in adults. European Journal of Neurology, 17: 348–355. doi: 10.1111/j.1468-1331.2009.02917.x
- Issue published online: 23 FEB 2010
- Article first published online: 30 DEC 2009
- Received 29 July 2009 Accepted 13 November 2009
- complex partial status epilepticus;
- generalised convulsive status epilepticus;
- refractory status epilepticus;
- subtle status epilepticus;
The objective of the current article was to review the literature and discuss the degree of evidence for various treatment strategies for status epilepticus (SE) in adults. We searched MEDLINE and EMBASE for relevant literature from 1966 to January 2005 and in the current updated version all pertinent publications from January 2005 to January 2009. Furthermore, the Cochrane Central Register of Controlled Trials (CENTRAL) was sought. Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach. Where there was a lack of evidence but consensus was clear, we have stated our opinion as good practice points. The preferred treatment pathway for generalised convulsive status epilepticus (GCSE) is intravenous (i.v.) administration of 4–8 mg lorazepam or 10 mg diazepam directly followed by 18 mg/kg phenytoin. If seizures continue more than 10 min after first injection, another 4 mg lorazepam or 10 mg diazepam is recommended. Refractory GCSE is treated by anaesthetic doses of barbiturates, midazolam or propofol; the anaesthetics are titrated against an electroencephalogram burst suppression pattern for at least 24 h. The initial therapy of non-convulsive SE depends on type and cause. Complex partial SE is initially treated in the same manner as GCSE. However, if it turns out to be refractory, further non-anaesthetising i.v. substances such levetiracetam, phenobarbital or valproic acid should be given instead of anaesthetics. In subtle SE, in most patients, i.v. anaesthesia is required.