Status epilepticus evaluation

It is important to evaluate for possible etiologies of status epilepticus and treat any underlying causes in order to optimize seizure control. 

The use of intravenous benzodiazepines administered by paramedics for the treatment of out-of-hospital status epilepticus has been evaluated in a double-blind, randomized trial in 205 adults (54). The patients presented either with seizures lasting 5 minutes or more or with repetitive generalized convulsive seizures, and were randomized to receive intravenous diazepam 5 mg, loraze-pam 2 mg, or placebo. Status epilepticus was controlled on arrival at the hospital in significantly more patients taking benzodiazepines than placebo (lorazepam 59%, diazepam 43%, placebo 21%). The rates of respiratory or circulatory complications related to drug treatment were 11% with lorazepam, 10% with diazepam, and 23% with placebo, but these differences were not significant. 

Drislane FW (1997). Status epilepticus. In The Comprehensive Evaluation and Treatment of Epilepsy (SC Schachter and DL Schomer, eds), pp. 149-172. San Diego, CA, USA Academic Press. 

The short-term effects of intravenous levetiracetam as the treatment of choice for status epilepticus have been evaluated in nine elderly patients (five women median age 78 years) [197 ]. In all but one, intravenous levetiracetam was effective and there were no adverse reactions or changes in electrocardiography or laboratory parameters. 

VPA versus phenytoin In a systemic review evaluating the efficacy and tolerability of intravenous VPA and intravenous phenytoin for convulsive status epilepticus, VPA had a significantly lower rate of adverse events compared to phenytoin (9.7% vs 34.8%). There was no statistically significant difference in seizure freedom at 24 h [32 ]. 

Observational studies A phase 111 study evaluated the safety and efficacy of levetiracetam in 217 children and adults with primary generalized seizures. The most common adverse effects reported by >10% participants were headache and nasopharyngitis. The most frequent treatment-associated adverse effects were headache (4.6%), dizziness and depression (both 4.1%). Serious adverse effects related to treatment with levetiracetam 4.6% of patients experienced convulsion, atrial fibrillation, epilepsy, depression, psychosis, schizophrenia, suicidal ideation, erythematous rash, and status epilepticus. One patient each discontinued due to the following adverse effects arrhythmia, convulsions, tremor, aggression, depression, psychosis, and exanthem. One patient with worsening of comorbid schizophrenia committed suicide it had been 43 days since he had last taken levetiracetam at the time [87 -]. 

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