Management of Status Epilepticus- American Family Physician

Although there is no consensus over a classification system for status epilepticus, classification is necessary for appropriate management of the condition because effective management depends on the type of status epilepticus. In general, the various systems characterize status epilepticus according to where the seizures arise—from a localized region of the cortex (partial onset) or from both hemispheres of the brain (generalized onset). The other major categorization hinges on the clinical observation of overt convulsions; thus, status epilepticus may be convulsive or nonconvulsive in nature. Various approaches to classifying status epilepticus have been suggested. One version classified status epilepticus into generalized (tonic-clonic, myoclonic, absence, atonic, akinetic) and partial (simple or complex) status epilepticus. Another version divides the condition into generalized status epilepticus S tatus epilepticus is an under-recognized health problem associated with substantial morbidity and mortality. An estimated 152,000 cases occur per year in the United States, resulting in 42,000 deaths and an inpatient cost of $3.8 to $7 billion per year. This review concentrates on the clinical management of status epilepticus (particularly convulsive status epilepticus), the theoretic and clinical considerations involved in choosing an antiepileptic drug to treat this emergency situation, and the consensus protocol devised by the Epilepsy Foundation of America (EFA) Working Group on Status Epilepticus.