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August 18, 1993, Vol 270, No. 7 >
ARTICLE | August 18, 1993

Treatment of Convulsive Status Epilepticus: Title and subTitle BreakRecommendations of the Epilepsy Foundation of America's Working Group on Status Epilepticus FREE

[+] Author Affiliations

Reprint requests to Epilepsy Foundation of America, 4351 Garden City Dr, Landover, MD 20785 (Dr Dodson). Members of the Writing Committee of the Working Group on Status Epilepticus are W. Edwin Dodson, MD, Robert J. DeLorenzo, MD, PhD, MPH, Timothy A. Pedley, MD, Shlomo Shinnar, MD, PhD, David M. Treiman, MD, and Braxton B. Wannamaker, MD.


JAMA. 1993;270(7):854-859. doi:10.1001/jama.1993.03510070076040
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References

Convulsive status epilepticus is an emergency that is associated with high morbidity and mortality. The outcome largely depends on etiology, but prompt and appropriate pharmacological therapy can reduce morbidity and mortality. Etiology varies in children and adults and reflects the distribution of disease in these age groups. Antiepileptic drug administration should be initiated whenever a seizure has lasted 10 minutes. Immediate concerns include supporting respiration, maintaining blood pressure, gaining intravenous access, and identifying and treating the underlying cause. Initial therapeutic and diagnostic measures are conducted simultaneously. The goal of therapy is rapid termination of clinical and electrical seizure activity; the longer a seizure continues, the greater the likelihood of an adverse outcome. Several drug protocols now in use will terminate status epilepticus. Common to all patients is the need for a clear plan, prompt administration of appropriate drugs in adequate doses, and attention to the possibility of apnea, hypoventilation, or other metabolic abnormalities.

(JAMA. 1993;270:854-859)

REFERENCES

1 +
Hauser WA.  Status epilepticus: epidemiologic considerations. Neurology . 1990;;40( (suppl 2) ):9-13.
2 +
Maytal J, Shinnar S, Moshe SL, et al.  Low morbidity and mortality of status epilepticus in children. Pediatrics . 1989;;83:323-331.
3 +
Dunn DW.  Status epilepticus in children: etiology, clinical features, and outcome. J Child Neurol . 1988;;3:167-173.
4 +
Gastaut H.  Clinical and electroencephalographical classification of epileptic seizures. Epilepsia . 1970;;11:102-113.
5 +
Commission on Classification and Terminology of the International League Against Epilepsy.  Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia . 1981;; 22:489-501.
6 +
Treiman DM, Delgado-Escueta AV.  Status epilepticus.  In: Thompson RA, Green JR, eds. Critical Care of Neurological and Neurosurgical Emergencies . New York, NY: Raven Press; 1980;:53-99.
7 +
Treiman DM.  Status epilepticus.  In: Laidlaw J, Richens A, Chadwick D, eds. A Textbook of Epilepsy . 4th ed. Edinburgh, Scotland: Churchill Livingstone; 1993;:205-220.
8 +
Treiman DM.  Status epilepticus.  In: Johnson RT, ed. Current Therapy of Neurologic Disease . 2nd ed. Philadelphia, Pa: BC Decker; 1987;:38-42.
9 +
Walton NY, Treiman DM.  Response of status epilepticus induced by lithium and pilocarpine to treatment with diazepam. Exp Neurol . 1988;;101: 267-275.
10 +
Treiman DM, Meyers PD, the DVA Status Epilepticus Cooperative Study Group.  Utility of the EEG pattern as a predictor of success in the treatment of generalized convulsive status epilepticus. Epilepsia . 1991;;32( (suppl 3) ):93.
11 +
DeLorenzo RJ, Towne AR, Pellock JM, et al.  Status epilepticus in children, adults, and the elderly. Epilepsia . 1992;;33( (suppl 4) ):S15-S25.
12 +
Aicardi J, Chevrie JJ.  Convulsive status epilepticus in infants and children: a study of 239 cases. Epilepsia . 1970;;11:187-197.
13 +
Rowan AJ, Scott DF.  Major status epilepticus. Acta Neurol Scand . 1970;;46:573-584.
14 +
Hauser WA, Anderson VE, Loewenson RB, et al.  Seizure recurrence after a first unprovoked seizure. N Engl J Med . 1982;;307:522-528.
15 +
Meldrum BS, Horton RW.  Physiology of status epilepticus in primates. Arch Neurol . 1973;;28:1-9.
16 +
Simon RP.  Physiologic consequences of status epilepticus. Epilepsia . 1985;;26( (suppl 1) ):S58-S66.
17 +
Lothman E.  The biochemical basis and pathophysiology of status epilepticus. Neurology . 1990;; 40( (suppl 2) ):13-23.
18 +
Treiman DM.  General principles of treatment: responsive and intractable status epilepticus in adults.  In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ, eds. Advances in Neurology, 34: Status Epilepticus: Mechanisms of Brain Damage and Treatment . New York, NY: Raven Press; 1983;:377-384.
19 +
Treiman DM.  Special treatment problems in adults.  In: Smith DB, ed. Epilepsy: Current Approaches to Diagnosis and Treatment . New York, NY: Raven Press; 1990;:155-172.
20 +
Treiman DM.  Pharmacokinetics and clinical use of benzodiazepines in the management of status epilepticus. Epilepsia . 1989;;30( (suppl 2) ):S4-S10.
21 +
Treiman DM.  The role of benzodiazepines in the management of status epilepticus. Neurology . 1990;;40( (suppl 2) ):32-42.
22 +
Walton NY, Treiman DM.  Lorazepam treatment of experimental status epilepticus in the rat: relevance to clinical practice. Neurology . 1990;;40: 990-994.
23 +
George KA, Dundee JW.  Relative amnestic actions of diazepam, flunitrazepam and lorazepam in man. Br J Clin Pharmacol . 1977;;4:45-50.
24 +
Dundee JW, McGowan WAW, Lilburn JK, et al.  Comparison of the actions of diazepam and lorazepam. Br J Anaesth . 1979;;51:439-446.
25 +
Leppik IE, Derivan AT, Homan RW, et al.  Double-blind study of lorazepam and diazepam in status epilepticus. JAMA . 1983;;249:1452-1454.
26 +
McWilliam PKA, Leeds MB.  Intravenous phenytoin sodium in continuous convulsions in children. Lancet . 1958;;2:1147-1149.
27 +
Wallis W, Kutt H, McDowell F.  Intravenous diphenylhydantoin in treatment of acute repetitive seizures. Neurology . 1968;;18:513-525.
28 +
Wilder BJ, Ramsay RE, Willmore LJ, et al.  Efficacy of intravenous phenytoin in the treatment of status epilepticus: kinetics of central nervous system penetration. Ann Neurol . 1977;;1:511-518.
29 +
Cranford RE, Leppik IE, Patrick B, et al.  Intravenous phenytoin in acute treatment of seizures. Neurology . 1979;;29:1474-1479.
30 +
Carter CH.  Use of parenteral diphenylhydantoin (Dilantin) sodium in control of status epilepticus. AMA Arch Neurol Psychiatry . 1958;;79:136-137.
31 +
Cranford RE, Leppik IE, Patrick B, et al.  Intravenous phenytoin: clinical and pharmacokinetic aspects. Neurology . 1978;;28:874-880.
32 +
Simon RP.  Management of status epilepticus.  In: Pedley TA, Meldrum BS, eds. Recent Advances in Epilepsy, No. 2 . New York, NY: Churchill Livingstone Inc; 1985;:137-160.
33 +
Shaner DM, McCurdy SA, Herring MO, et al.  Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology . 1988;;38: 202-207.
34 +
Dulac O, Aicardi J, Rey E, et al.  Blood levels of diazepam after single rectal administration in infants and children. J Pediatr . 1978;;93:1039-1041.
35 +
Curless RG, Holzman BH, Ramsay RE.  Paraldehyde therapy in childhood status epilepticus. Arch Neurol . 1983;;40:477-480.
36 +
Giacoia GP, Gessner PK, Zaleska MM, et al.  Pharmacokinetics of paraldehyde disposition in the neonate. J Pediatr . 1984;;104:291-296.
37 +
Thorpy MJ.  Rectal valproate syrup and status epilepticus. Neurology . 1980;;30:1113-1114.
38 +
Snead OC III, Miles MV.  Treatment of status epilepticus in children with rectal sodium valproate. J Pediatr . 1985;;106:323-325.
39 +
Dodrill CB, Wilensky AJ.  Intellectual impairment as an outcome of status epilepticus. Neurology . 1990;;40( (suppl 2) ):23-27.
40 +
Ellenberg JH, Nelson KB.  Febrile seizures and later intellectual performance. Arch Neurol . 1978;; 35:17-21.
41 +
Towne AR, McGee FE, Mercer EL, et al.  Mortality in a community-based status epilepticus study. Neurology . 1990;;40( (suppl 1) ):299.
42 +
Aminoff M, Simon R.  Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med . 1980;;69:657-666.
43 +
Hauser WA, Hesdorffer DC. Epilepsy: Frequency, Causes, and Consequences . New York, NY: Demos; 1990;.
44 +
Driscoll SM, Towne AR, Pellock JM, et al.  Recurrent status epilepticus in children. Neurology . 1990;;40( (suppl 1) ):297.
45 +
Shinnar S, Maytal J, Krasnoff L, et al.  Recurrent status epilepticus in children. Ann Neurol . 1992;;31:598-604.
46 +
Berg AT, Shinnar S.  The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology . 1991;;41:965-972.
47 +
Shinnar S, Berg AT, Moshe SL, et al.  Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study. Pediatrics . 1990;;85:1076-1085.
48 +
van Donselaar CA, Schimsheimer RJ, Geerts AT, et al.  Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol . 1992;;49:231-237.
49 +
Annegers JF, Hauser WA, Shirts SB, et al.  Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med . 1987;;316:493-498.
50 +
National Institutes of Health. Febrile Seizures: Consensus Development Conference Summary . Bethesda, Md: National Institutes of Health; 1980;;3. No. 2.
51 +
Nelson KB, Ellenberg JH.  Prognosis in children with febrile seizures. Pediatrics . 1978;;61:720-727.
52 +
Maytal J, Shinnar S.  Febrile status epilepticus. Pediatrics . 1990;;86:611-616.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hauser WA.  Status epilepticus: epidemiologic considerations. Neurology . 1990;;40( (suppl 2) ):9-13.
2 +
Maytal J, Shinnar S, Moshe SL, et al.  Low morbidity and mortality of status epilepticus in children. Pediatrics . 1989;;83:323-331.
3 +
Dunn DW.  Status epilepticus in children: etiology, clinical features, and outcome. J Child Neurol . 1988;;3:167-173.
4 +
Gastaut H.  Clinical and electroencephalographical classification of epileptic seizures. Epilepsia . 1970;;11:102-113.
5 +
Commission on Classification and Terminology of the International League Against Epilepsy.  Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia . 1981;; 22:489-501.
6 +
Treiman DM, Delgado-Escueta AV.  Status epilepticus.  In: Thompson RA, Green JR, eds. Critical Care of Neurological and Neurosurgical Emergencies . New York, NY: Raven Press; 1980;:53-99.
7 +
Treiman DM.  Status epilepticus.  In: Laidlaw J, Richens A, Chadwick D, eds. A Textbook of Epilepsy . 4th ed. Edinburgh, Scotland: Churchill Livingstone; 1993;:205-220.
8 +
Treiman DM.  Status epilepticus.  In: Johnson RT, ed. Current Therapy of Neurologic Disease . 2nd ed. Philadelphia, Pa: BC Decker; 1987;:38-42.
9 +
Walton NY, Treiman DM.  Response of status epilepticus induced by lithium and pilocarpine to treatment with diazepam. Exp Neurol . 1988;;101: 267-275.
10 +
Treiman DM, Meyers PD, the DVA Status Epilepticus Cooperative Study Group.  Utility of the EEG pattern as a predictor of success in the treatment of generalized convulsive status epilepticus. Epilepsia . 1991;;32( (suppl 3) ):93.
11 +
DeLorenzo RJ, Towne AR, Pellock JM, et al.  Status epilepticus in children, adults, and the elderly. Epilepsia . 1992;;33( (suppl 4) ):S15-S25.
12 +
Aicardi J, Chevrie JJ.  Convulsive status epilepticus in infants and children: a study of 239 cases. Epilepsia . 1970;;11:187-197.
13 +
Rowan AJ, Scott DF.  Major status epilepticus. Acta Neurol Scand . 1970;;46:573-584.
14 +
Hauser WA, Anderson VE, Loewenson RB, et al.  Seizure recurrence after a first unprovoked seizure. N Engl J Med . 1982;;307:522-528.
15 +
Meldrum BS, Horton RW.  Physiology of status epilepticus in primates. Arch Neurol . 1973;;28:1-9.
16 +
Simon RP.  Physiologic consequences of status epilepticus. Epilepsia . 1985;;26( (suppl 1) ):S58-S66.
17 +
Lothman E.  The biochemical basis and pathophysiology of status epilepticus. Neurology . 1990;; 40( (suppl 2) ):13-23.
18 +
Treiman DM.  General principles of treatment: responsive and intractable status epilepticus in adults.  In: Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ, eds. Advances in Neurology, 34: Status Epilepticus: Mechanisms of Brain Damage and Treatment . New York, NY: Raven Press; 1983;:377-384.
19 +
Treiman DM.  Special treatment problems in adults.  In: Smith DB, ed. Epilepsy: Current Approaches to Diagnosis and Treatment . New York, NY: Raven Press; 1990;:155-172.
20 +
Treiman DM.  Pharmacokinetics and clinical use of benzodiazepines in the management of status epilepticus. Epilepsia . 1989;;30( (suppl 2) ):S4-S10.
21 +
Treiman DM.  The role of benzodiazepines in the management of status epilepticus. Neurology . 1990;;40( (suppl 2) ):32-42.
22 +
Walton NY, Treiman DM.  Lorazepam treatment of experimental status epilepticus in the rat: relevance to clinical practice. Neurology . 1990;;40: 990-994.
23 +
George KA, Dundee JW.  Relative amnestic actions of diazepam, flunitrazepam and lorazepam in man. Br J Clin Pharmacol . 1977;;4:45-50.
24 +
Dundee JW, McGowan WAW, Lilburn JK, et al.  Comparison of the actions of diazepam and lorazepam. Br J Anaesth . 1979;;51:439-446.
25 +
Leppik IE, Derivan AT, Homan RW, et al.  Double-blind study of lorazepam and diazepam in status epilepticus. JAMA . 1983;;249:1452-1454.
26 +
McWilliam PKA, Leeds MB.  Intravenous phenytoin sodium in continuous convulsions in children. Lancet . 1958;;2:1147-1149.
27 +
Wallis W, Kutt H, McDowell F.  Intravenous diphenylhydantoin in treatment of acute repetitive seizures. Neurology . 1968;;18:513-525.
28 +
Wilder BJ, Ramsay RE, Willmore LJ, et al.  Efficacy of intravenous phenytoin in the treatment of status epilepticus: kinetics of central nervous system penetration. Ann Neurol . 1977;;1:511-518.
29 +
Cranford RE, Leppik IE, Patrick B, et al.  Intravenous phenytoin in acute treatment of seizures. Neurology . 1979;;29:1474-1479.
30 +
Carter CH.  Use of parenteral diphenylhydantoin (Dilantin) sodium in control of status epilepticus. AMA Arch Neurol Psychiatry . 1958;;79:136-137.
31 +
Cranford RE, Leppik IE, Patrick B, et al.  Intravenous phenytoin: clinical and pharmacokinetic aspects. Neurology . 1978;;28:874-880.
32 +
Simon RP.  Management of status epilepticus.  In: Pedley TA, Meldrum BS, eds. Recent Advances in Epilepsy, No. 2 . New York, NY: Churchill Livingstone Inc; 1985;:137-160.
33 +
Shaner DM, McCurdy SA, Herring MO, et al.  Treatment of status epilepticus: a prospective comparison of diazepam and phenytoin versus phenobarbital and optional phenytoin. Neurology . 1988;;38: 202-207.
34 +
Dulac O, Aicardi J, Rey E, et al.  Blood levels of diazepam after single rectal administration in infants and children. J Pediatr . 1978;;93:1039-1041.
35 +
Curless RG, Holzman BH, Ramsay RE.  Paraldehyde therapy in childhood status epilepticus. Arch Neurol . 1983;;40:477-480.
36 +
Giacoia GP, Gessner PK, Zaleska MM, et al.  Pharmacokinetics of paraldehyde disposition in the neonate. J Pediatr . 1984;;104:291-296.
37 +
Thorpy MJ.  Rectal valproate syrup and status epilepticus. Neurology . 1980;;30:1113-1114.
38 +
Snead OC III, Miles MV.  Treatment of status epilepticus in children with rectal sodium valproate. J Pediatr . 1985;;106:323-325.
39 +
Dodrill CB, Wilensky AJ.  Intellectual impairment as an outcome of status epilepticus. Neurology . 1990;;40( (suppl 2) ):23-27.
40 +
Ellenberg JH, Nelson KB.  Febrile seizures and later intellectual performance. Arch Neurol . 1978;; 35:17-21.
41 +
Towne AR, McGee FE, Mercer EL, et al.  Mortality in a community-based status epilepticus study. Neurology . 1990;;40( (suppl 1) ):299.
42 +
Aminoff M, Simon R.  Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med . 1980;;69:657-666.
43 +
Hauser WA, Hesdorffer DC. Epilepsy: Frequency, Causes, and Consequences . New York, NY: Demos; 1990;.
44 +
Driscoll SM, Towne AR, Pellock JM, et al.  Recurrent status epilepticus in children. Neurology . 1990;;40( (suppl 1) ):297.
45 +
Shinnar S, Maytal J, Krasnoff L, et al.  Recurrent status epilepticus in children. Ann Neurol . 1992;;31:598-604.
46 +
Berg AT, Shinnar S.  The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology . 1991;;41:965-972.
47 +
Shinnar S, Berg AT, Moshe SL, et al.  Risk of seizure recurrence following a first unprovoked seizure in childhood: a prospective study. Pediatrics . 1990;;85:1076-1085.
48 +
van Donselaar CA, Schimsheimer RJ, Geerts AT, et al.  Value of the electroencephalogram in adult patients with untreated idiopathic first seizures. Arch Neurol . 1992;;49:231-237.
49 +
Annegers JF, Hauser WA, Shirts SB, et al.  Factors prognostic of unprovoked seizures after febrile convulsions. N Engl J Med . 1987;;316:493-498.
50 +
National Institutes of Health. Febrile Seizures: Consensus Development Conference Summary . Bethesda, Md: National Institutes of Health; 1980;;3. No. 2.
51 +
Nelson KB, Ellenberg JH.  Prognosis in children with febrile seizures. Pediatrics . 1978;;61:720-727.
52 +
Maytal J, Shinnar S.  Febrile status epilepticus. Pediatrics . 1990;;86:611-616.

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