PDF herunterladen
Semin Neurol 2016; 36(06): 550-559
DOI: 10.1055/s-0036-1592357
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Status Epilepticus in the Intensive Care Unit

Adriana Bermeo-Ovalle
1   Division of Electroencephalography, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
,
Thomas Bleck
2   Division of Clinical Neurophysiology, Department of Neurological Sciences, Neurosurgery, Anesthesiology, and Medicine, Rush University Medical Center, Chicago, Illinois
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
01. Dezember 2016 (online)

    Lizenzen und Reprints

Abstract

Status epilepticus (SE) is a common neurologic emergency and a frequent reason for admission to the intensive care unit. During the last decade, the advent and availability of diagnostic tools for the recognition of nonconvulsive SE has highlighted an even higher incidence of this condition among the critically ill. New alternatives in treatment have also become available within recent years. The recommendation of early escalation toward the use of general anesthetics in the treatment of convulsive SE follows the theory that the duration of the event defines the aggressiveness of the condition and the potential for long-term neuronal injury. Whether these new diagnostic and treatment tools are applicable to all patients with SE; and how they impact functional outcome and mortality, remain active subjects of clinical research.

Keywords

status epilepticus - intensive care unit - continuous electroencephalogram - antiepileptic drugs - treatment - prognosis
 

  • References

  • 1 Hantus S. Epilepsy emergencies. Continuum (Minneap Minn) 2016; 22 (1 Epilepsy): 173-190
    PubMedSuche in Google Scholar
  • 2 Dham BS, Hunter K, Rincon F. The epidemiology of status epilepticus in the United States. Neurocrit Care 2014; 20 (3) 476-483
    CrossrefPubMedSuche in Google Scholar
  • 3 Logroscino G, Hesdorffer DC, Cascino G , et al. Mortality after a first episode of status epilepticus in the United States and Europe. Epilepsia 2005; 46 (Suppl. 11) 46-48
    PubMedSuche in Google Scholar
  • 4 Towne AR, Waterhouse EJ, Boggs JG , et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 2000; 54 (2) 340-345
    CrossrefPubMedSuche in Google Scholar
  • 5 Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ. Continuous electroencephalography in the medical intensive care unit. Crit Care Med 2009; 37 (6) 2051-2056
    CrossrefPubMedSuche in Google Scholar
  • 6 Zacharia BE, Vaughan KA, Bruce SS , et al. Epidemiological trends in the neurological intensive care unit from 2000 to 2008. J Clin Neurosci 2012; 19 (12) 1668-1672
    CrossrefPubMedSuche in Google Scholar
  • 7 Rossetti AO, Hurwitz S, Logroscino G, Bromfield EB. Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry 2006; 77 (5) 611-615
    CrossrefPubMedSuche in Google Scholar
  • 8 Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia 1994; 35 (1) 27-34
    CrossrefPubMedSuche in Google Scholar
  • 9 Betjemann JP, Josephson SA, Lowenstein DH, Burke JF. Trends in status epilepticus-related hospitalizations and mortality: Redefined in US practice over time. JAMA Neurol 2015; 72 (6) 650-655
    CrossrefPubMedSuche in Google Scholar
  • 10 Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia 2006; 47 (9) 1499-1503
    CrossrefPubMedSuche in Google Scholar
  • 11 Lowenstein DH, Bleck T, Macdonald RL. It's time to revise the definition of status epilepticus. Epilepsia 1999; 40 (1) 120-122
    CrossrefPubMedSuche in Google Scholar
  • 12 Trinka E, Cock H, Hesdorffer D , et al. A definition and classification of status epilepticus–report of the ILAE task force on classification of status epilepticus. Epilepsia 2015; 56 (10) 1515-1523
    CrossrefPubMedSuche in Google Scholar
  • 13 Meldrum BS, Brierley JB. Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. Arch Neurol 1973; 28 (1) 10-17
    CrossrefPubMedSuche in Google Scholar
  • 14 Engel Jr J. So what can we conclude—do seizures damage the brain?. Prog Brain Res 2002; 135: 509-512
    PubMedSuche in Google Scholar
  • 15 Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clin Proc 1996; 71 (6) 576-586
    CrossrefPubMedSuche in Google Scholar
  • 16 Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. How common are the “common” neurologic disorders?. Neurology 2007; 68 (5) 326-337
    CrossrefPubMedSuche in Google Scholar
  • 17 Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965-1984. Neurology 1998; 50 (3) 735-741
    CrossrefPubMedSuche in Google Scholar
  • 18 DeLorenzo RJ, Pellock JM, Towne AR, Boggs JG. Epidemiology of status epilepticus. J Clin Neurophysiol 1995; 12 (4) 316-325
    CrossrefPubMedSuche in Google Scholar
  • 19 Garzon E, Fernandes RM, Sakamoto AC. Analysis of clinical characteristics and risk factors for mortality in human status epilepticus. Seizure 2003; 12 (6) 337-345
    CrossrefPubMedSuche in Google Scholar
  • 20 Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology 2000; 55 (5) 693-697
    CrossrefPubMedSuche in Google Scholar
  • 21 Betjemann JP. Current trends in treatment of status epilepticus and refractory status epilepticus. Semin Neurol 2015; 35 (6) 621-628
    Thieme ConnectPubMedSuche in Google Scholar
  • 22 Delanty N, French JA, Labar DR, Pedley TA, Rowan AJ. Status epilepticus arising de novo in hospitalized patients: an analysis of 41 patients. Seizure 2001; 10 (2) 116-119
    CrossrefPubMedSuche in Google Scholar
  • 23 Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 1996; 47 (1) 83-89
    CrossrefPubMedSuche in Google Scholar
  • 24 Zhou B, Huang Y, Wang J , et al. The aetiology of convulsive status epilepticus: a study of 258 cases in Western China. Seizure 2014; 23 (9) 717-721
    CrossrefPubMedSuche in Google Scholar
  • 25 Gaspard N, Foreman BP, Alvarez V , et al; Critical Care EEG Monitoring Research Consortium (CCEMRC). New-onset refractory status epilepticus: Etiology, clinical features, and outcome. Neurology 2015; 85 (18) 1604-1613
    CrossrefPubMedSuche in Google Scholar
  • 26 Glaser CA, Gilliam S, Honarmand S , et al. Refractory status epilepticus in suspect encephalitis. Neurocrit Care 2008; 9 (1) 74-82
    CrossrefPubMedSuche in Google Scholar
  • 27 Wasterlain CG, Naylor DE, Liu H, Niquet J, Baldwin R. Trafficking of NMDA receptors during status epilepticus: therapeutic implications. Epilepsia 2013; 54 (Suppl. 06) 78-80
    CrossrefPubMedSuche in Google Scholar
  • 28 Naylor DE. Glutamate and GABA in the balance: convergent pathways sustain seizures during status epilepticus. Epilepsia 2010; 51 (Suppl. 03) 106-109
    CrossrefPubMedSuche in Google Scholar
  • 29 Hillert MH, Imran I, Zimmermann M, Lau H, Weinfurter S, Klein J. Dynamics of hippocampal acetylcholine release during lithium-pilocarpine-induced status epilepticus in rats. J Neurochem 2014; 131 (1) 42-52
    CrossrefPubMedSuche in Google Scholar
  • 30 Vezzani A, Lang B, Aronica E. Immunity and inflammation in epilepsy. Cold Spring Harb Perspect Med 2016; 6 (2) a022699
    CrossrefPubMedSuche in Google Scholar
  • 31 Gorter JA, van Vliet EA, Aronica E. Status epilepticus, blood–brain barrier disruption, inflammation, and epileptogenesis. Epilepsy Behav 2015; 49: 13-16
    CrossrefPubMedSuche in Google Scholar
  • 32 Miller-Delaney SF, Das S, Sano T , et al. Differential DNA methylation patterns define status epilepticus and epileptic tolerance. J Neurosci 2012; 32 (5) 1577-1588
    CrossrefPubMedSuche in Google Scholar
  • 33 Jimenez-Mateos EM, Henshall DC. Epilepsy and microRNA. Neuroscience 2013; 238: 218-229
    CrossrefPubMedSuche in Google Scholar
  • 34 DeLorenzo RJ, Waterhouse EJ, Towne AR , et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia 1998; 39 (8) 833-840
    CrossrefPubMedSuche in Google Scholar
  • 35 Sutter R. Are we prepared to detect subtle and nonconvulsive status epilepticus in critically ill patients?. J Clin Neurophysiol 2016; 33 (1) 25-31
    CrossrefPubMedSuche in Google Scholar
  • 36 Sutter R, Kaplan PW. Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia 2012; 53 (Suppl. 03) 1-51
    PubMedSuche in Google Scholar
  • 37 Bleck TP, Smith MC, Pierre-Louis SJ, Jares JJ, Murray J, Hansen CA. Neurologic complications of critical medical illnesses. Crit Care Med 1993; 21 (1) 98-103
    CrossrefPubMedSuche in Google Scholar
  • 38 Laccheo I, Sonmezturk H, Bhatt AB , et al. Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients. Neurocrit Care 2015; 22 (2) 202-211
    CrossrefPubMedSuche in Google Scholar
  • 39 Baguley IJ, Perkes IE, Fernandez-Ortega JF, Rabinstein AA, Dolce G, Hendricks HT ; Consensus Working Group. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma 2014; 31 (17) 1515-1520
    CrossrefPubMedSuche in Google Scholar
  • 40 Kang BS, Kim DW, Kim KK , et al. Prediction of mortality and functional outcome from status epilepticus and independent external validation of STESS and EMSE scores. Crit Care 2016; 20 (1) 25
    PubMedSuche in Google Scholar
  • 41 Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB. Status Epilepticus Severity Score (STESS): a tool to orient early treatment strategy. J Neurol 2008; 255 (10) 1561-1566
    CrossrefPubMedSuche in Google Scholar
  • 42 Leitinger M, Höller Y, Kalss G , et al. Epidemiology-based mortality score in status epilepticus (EMSE). Neurocrit Care 2015; 22 (2) 273-282
    CrossrefPubMedSuche in Google Scholar
  • 43 Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 2004; 62 (10) 1743-1748
    CrossrefPubMedSuche in Google Scholar
  • 44 Kamel H, Betjemann JP, Navi BB , et al. Diagnostic yield of electroencephalography in the medical and surgical intensive care unit. Neurocrit Care 2013; 19 (3) 336-341
    CrossrefPubMedSuche in Google Scholar
  • 45 Sutter R, Rüegg S, Tschudin-Sutter S. Seizures as adverse events of antibiotic drugs: a systematic review. Neurology 2015; 85 (15) 1332-1341
    CrossrefPubMedSuche in Google Scholar
  • 46 Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M ; Neurointensive Care Section of the European Society of Intensive Care Medicine. Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med 2013; 39 (8) 1337-1351
    CrossrefPubMedSuche in Google Scholar
  • 47 Herman ST, Abend NS, Bleck TP , et al; Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol 2015; 32 (2) 87-95
    CrossrefPubMedSuche in Google Scholar
  • 48 Sackellares JC, Shiau DS, Halford JJ, LaRoche SM, Kelly KM. Quantitative EEG analysis for automated detection of nonconvulsive seizures in intensive care units. Epilepsy Behav 2011; 22 (Suppl. 01) S69-S73
    CrossrefPubMedSuche in Google Scholar
  • 49 Jeppesen J, Fuglsang-Frederiksen A, Brugada R , et al. Heart rate variability analysis indicates preictal parasympathetic overdrive preceding seizure-induced cardiac dysrhythmias leading to sudden unexpected death in a patient with epilepsy. Epilepsia 2014; 55 (7) e67-e71
    CrossrefPubMedSuche in Google Scholar
  • 50 Chanson E, Bicilli É, Lauxerois M , et al. Anti-NMDA-R encephalitis: should we consider extreme delta brush as electrical status epilepticus?. Neurophysiol Clin 2016; 46 (1) 17-25
    CrossrefPubMedSuche in Google Scholar
  • 51 Cartagena AM, Young GB, Lee DH, Mirsattari SM. Reversible and irreversible cranial MRI findings associated with status epilepticus. Epilepsy Behav 2014; 33: 24-30
    CrossrefPubMedSuche in Google Scholar
  • 52 Helbok R, Claassen J. Multimodal invasive monitoring in status epilepticus: what is the evidence it has a place?. Epilepsia 2013; 54 (Suppl. 06) 57-60
    CrossrefPubMedSuche in Google Scholar
  • 53 Bleck TP. Status epilepticus and the use of continuous EEG monitoring in the intensive care unit. Continuum (Minneap Minn) 2012; 18 (3) 560-578
    PubMedSuche in Google Scholar
  • 54 Prasad M, Krishnan PR, Sequeira R, Al-Roomi K. Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev 2014; 9 (9) CD003723
    PubMedSuche in Google Scholar
  • 55 Jones DM, Esmaeil N, Maren S, Macdonald RL. Characterization of pharmacoresistance to benzodiazepines in the rat Li-pilocarpine model of status epilepticus. Epilepsy Res 2002; 50 (3) 301-312
    CrossrefPubMedSuche in Google Scholar
  • 56 Alldredge BK, Gelb AM, Isaacs SM , et al. A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 2001; 345 (9) 631-637
    CrossrefPubMedSuche in Google Scholar
  • 57 Kälviäinen R. Intranasal therapies for acute seizures. Epilepsy Behav 2015; 49: 303-306
    CrossrefPubMedSuche in Google Scholar
  • 58 Glauser T, Shinnar S, Gloss D , et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: Report of the guideline committee of the American Epilepsy Society. Epilepsy Curr 2016; 16 (1) 48-61
    CrossrefPubMedSuche in Google Scholar
  • 59 Grover EH, Nazzal Y, Hirsch LJ. Treatment of convulsive status epilepticus. Curr Treat Options Neurol 2016; 18 (3) 11
    CrossrefPubMedSuche in Google Scholar
  • 60 Misra UK, Kalita J, Maurya PK. Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled pilot study. J Neurol 2012; 259 (4) 645-648
    CrossrefPubMedSuche in Google Scholar
  • 61 Ramsay RE, Sabharwal V, Khan F , et al. Safety & pK of IV loading dose of lacosamide in the ICU. Epilepsy Behav 2015; 49: 340-342
    CrossrefPubMedSuche in Google Scholar
  • 62 Miró J, Toledo M, Santamarina E , et al. Efficacy of intravenous lacosamide as an add-on treatment in refractory status epilepticus: a multicentric prospective study. Seizure 2013; 22 (1) 77-79
    CrossrefPubMedSuche in Google Scholar
  • 63 Bleck T, Cock H, Chamberlain J , et al. The established status epilepticus trial 2013. Epilepsia 2013; 54 (Suppl. 06) 89-92
    PubMedSuche in Google Scholar
  • 64 Löscher W. Single versus combinatorial therapies in status epilepticus: novel data from preclinical models. Epilepsy Behav 2015; 49: 20-25
    CrossrefPubMedSuche in Google Scholar
  • 65 Wasterlain CG, Baldwin R, Naylor DE, Thompson KW, Suchomelova L, Niquet J. Rational polytherapy in the treatment of acute seizures and status epilepticus. Epilepsia 2011; 52 (Suppl. 08) 70-71
    PubMedSuche in Google Scholar
  • 66 Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain 2012; 135 (Pt 8) 2314-2328
    CrossrefPubMedSuche in Google Scholar
  • 67 Vooturi S, Jayalakshmi S, Sahu S, Mohandas S. Prognosis and predictors of outcome of refractory generalized convulsive status epilepticus in adults treated in neurointensive care unit. Clin Neurol Neurosurg 2014; 126: 7-10
    CrossrefPubMedSuche in Google Scholar
  • 68 Betjemann JP, Lowenstein DH. Status epilepticus in adults. Lancet Neurol 2015; 14 (6) 615-624
    CrossrefPubMedSuche in Google Scholar
  • 69 Jayalakshmi S, Vooturi S, Sahu S, Yada PK, Mohandas S. Causes and outcomes of new onset status epilepticus and predictors of refractoriness to therapy. J Clin Neurosci 2016; 26: 89-94
    CrossrefPubMedSuche in Google Scholar
  • 70 Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 2002; 59 (2) 205-210
    CrossrefPubMedSuche in Google Scholar
  • 71 Gaspard N, Foreman B, Judd LM , et al. Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study. Epilepsia 2013; 54 (8) 1498-1503
    CrossrefPubMedSuche in Google Scholar
  • 72 Rogawski MA, Loya CM, Reddy K, Zolkowska D, Lossin C. Neuroactive steroids for the treatment of status epilepticus. Epilepsia 2013; 54 (Suppl. 06) 93-98
    CrossrefPubMedSuche in Google Scholar
  • 73 Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain 2011; 134 (Pt 10) 2802-2818
    CrossrefPubMedSuche in Google Scholar
  • 74 Ma X, Liporace J, O'Connor MJ, Sperling MR. Neurosurgical treatment of medically intractable status epilepticus. Epilepsy Res 2001; 46 (1) 33-38
    CrossrefPubMedSuche in Google Scholar
  • 75 Alexopoulos A, Lachhwani DK, Gupta A , et al. Resective surgery to treat refractory status epilepticus in children with focal epileptogenesis. Neurology 2005; 64 (3) 567-570
    CrossrefPubMedSuche in Google Scholar
  • 76 Lhatoo SD, Alexopoulos AV. The surgical treatment of status epilepticus. Epilepsia 2007; 48 (Suppl. 08) 61-65
    CrossrefPubMedSuche in Google Scholar
  • 77 Zeiler FA, Zeiler KJ, Teitelbaum J, Gillman LM, West M. Therapeutic hypothermia for refractory status epilepticus. Can J Neurol Sci 2015; 42 (4) 221-229
    CrossrefPubMedSuche in Google Scholar
  • 78 Thakur KT, Probasco JC, Hocker SE , et al. Ketogenic diet for adults in super-refractory status epilepticus. Neurology 2014; 82 (8) 665-670
    CrossrefPubMedSuche in Google Scholar
  • 79 Cobo NH, Sankar R, Murata KK, Sewak SL, Kezele MA, Matsumoto JH. The ketogenic diet as broad-spectrum treatment for super-refractory pediatric status epilepticus: challenges in implementation in the pediatric and neonatal intensive care units. J Child Neurol 2015; 30 (2) 259-266
    CrossrefPubMedSuche in Google Scholar
  • 80 Zeiler FA, Zeiler KJ, Teitelbaum J, Gillman LM, West M. VNS for refractory status epilepticus. Epilepsy Res 2015; 112: 100-113
    CrossrefPubMedSuche in Google Scholar
  • 81 Zeiler FA, Matuszczak M, Teitelbaum J, Gillman LM, Kazina CJ. Transcranial magnetic stimulation for status epilepticus. Epilepsy Res Treat 2015; 2015: 678074
    PubMedSuche in Google Scholar
  • 82 D'Giano CH, Del C García M, Pomata H, Rabinowicz AL. Treatment of refractory partial status epilepticus with multiple subpial transection: case report. Seizure 2001; 10 (5) 382-385
    CrossrefPubMedSuche in Google Scholar
  • 83 Zeiler FA, Matuszczak M, Teitelbaum J, Gillman LM, Kazina CJ. Electroconvulsive therapy for refractory status epilepticus: A systematic review. Seizure 2016; 35: 23-32
    CrossrefPubMedSuche in Google Scholar
  • 84 Alvarez V, Drislane FW. Is favorable outcome possible after prolonged refractory status epilepticus?. J Clin Neurophysiol 2016; 33 (1) 32-41
    CrossrefPubMedSuche in Google Scholar