Epilepsy Emergencies.

Abstract

Epilepsy emergencies include acute repetitive seizures and status epilepticus. Their prognosis depends on the etiology of the seizures and the time spent in status epilepticus. This review discusses the current perspective on the diagnosis and treatment of status epilepticus and acute repetitive seizures in the intensive care unit. Current data on the treatment of status epilepticus emphasize early treatment over the choice of antiepileptic drug. The Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) data support the efficacy of prehospital treatment using faster routes of benzodiazepine administration. As additional antiepileptic drugs have become available in an IV formulation, their use in status epilepticus has increased, with little data to guide their administration. Recent publications have also stressed the changing epidemiology of status epilepticus in the United States, with a rise in incidence without much change in overall mortality. This rise is likely related to improved diagnostic capabilities with better availability and usage of continuous EEG in the intensive care unit and to the aging of the patient population. Acute repetitive seizures and status epilepticus are neurologic emergencies that are being increasingly diagnosed and treated in the modern era. Rapid treatment may influence patient prognosis, future cognitive outcomes, and the long-term potential for developing epilepsy. However, little is known about the mechanisms that perpetuate seizure activity, and our ability to intervene and prevent this condition remains limited. Preventing complications during the treatment of status epilepticus plays a large role in prognosis and the chance of treatment success.