Jędrzejczak J, Mazurkiewicz-Bełdzińska M, Szmuda M, Majkowska-Zwolińska B, Steinborn B, Ryglewicz D, Owczuk R, Bartkowska-Śniatkowska A, Widera E, Rejdak K, Siemiński M, Nagańska E
Department of Neurology and Epileptology, Centre of Postgraduate Medical Education, Warsaw, Poland.
Department of Developmental Neurology, Chair of Neurology, Medical University of Gdańsk, Poland.
Neurol Neurochir Pol. 2018 Aug;52(4):419-426. doi: 10.1016/j.pjnns.2018.04.002. Epub 2018 Jun 13.
The Working Group was established at the initiative of the General Board of the Polish Society of Epileptology (PSE) to develop an expert position on the treatment of convulsive status epilepticus (SE) in adults and children in Poland. Generalized convulsive SE is the most common form and also represents the greatest threat to life, highlighting the importance of the choice of appropriate therapeutic treatment.
We present the therapeutic options separately for treatment during the early preclinical (>5-30min), established (30-60min), and refractory (>60min) SE phases. This division is based on time and response to AEDs, and indicates a practical approach based on pathophysiological data.
Benzodiazepines (BZD) are the first-line drugs. In cases of ineffective first-line treatment and persistence of the seizure, the use of second-line treatment: phenytoin, valproic acid or phenobarbital is required. SE that persists after the administration of benzodiazepines and phenytoin or another second-line AED at appropriate doses is defined as refractory and drug resistant and requires treatment in the intensive care unit (ICU). EEG monitoring is essential during therapy at this stage. Anesthesia is typically continued for an initial period of 24h followed by a slow reversal and is re-established if seizures recur. Anesthesia is usually administered either to the level of the "burst suppression pattern" or to obtain the "EEG suppression" pattern.
Experts agree that close and early cooperation with a neurologist and anesthetist aiming to reduce the risk of pharmacoresistant cases is an extremely important factor in the treatment of patients with SE. This report has educational, practical and organizational aspects, outlining a standard plan for SE management in Poland that will improve therapeutic efficacy.
