New Guidelines Issued for Treatment of Prolonged Seizures
Continuous or rapid sequential seizure activity for 30 minutes or more (known as status epilepticus) is a medical emergency with a high mortality rate in both children and adults. Prompt and effective treatment is key. Consequently, the American Epilepsy Society (AES) has released a new guideline to help physicians, hospitals and health systems treat patients effectively.
Each year, between 50,000 and 150,000 Americans have status epilepticus with rates of death estimated at less than 3 percent for children and up to 30 percent for adults.
The new guideline focuses on the most common type of status epilepticus that is also associated with substantial mortality – convulsive status epilepticus.
“This is a valuable new guideline for both children and adults that could change the approach many clinicians take in treating these seizure emergencies,” said Tracy Glauser, MD, director, Comprehensive Epilepsy Center and author of the new guideline. “The goal of therapy is the rapid termination of the seizure activity to reduce neurological injuries and deaths.”
Current treatment approaches vary dramatically. Some therapies focus on reducing rather than ending the seizures and use inefficient therapies such as sedatives and paralytics or insufficient doses of anticonvulsants.
The guideline, which reviewed all available adult and pediatric evidence, provides a treatment algorithm that comprises three phases of treatment following a stabilization phase for initial first aid and assessment. It also offers evidence-based answers to the effectiveness, safety and tolerability questions regarding the treatment of convulsive status epilepticus. Depending on the causes or severity of the seizure, the guideline found evidence that clinicians may go through the phases faster than outlined or even skip the second treatment phase.
“In treating status epilepticus, there is an overriding urgency to stop seizures before the 30-minute mark when seizure-associated neurologic injury can occur,” said guideline coauthor Shlomo Shinnar, MD, PhD, with Albert Einstein College of Medicine and Montefiore Medical Center. “This guideline supports an aggressive approach to treating status epilepticus and seeks to bring some structure to what can often be a chaotic and dire medical situation.”
The guideline is published in the January/February issue of the AES journal Epilepsy Currents.
