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87 Status Epilepticus

701

 

 

Hence, long-term agents should be on board and all levels are well maintained before new drugs are added or tapering is begun (F ig. 87.1).

Suggested Reading

1.Castro Conde JR, Hernandez Borges AA, Domenech Martinez E, Gonzalez Campo C, Perera Soler R. Midazolam in neonatal seizures with no response to phenobarbital. Neurology. 2005;64(5):876–9.

Nonresponders to phenobarbital/phenytoin had a significantly worse outcome than responders. This study shows that midazolam effectively controls seizures in nonresponders to phenobarbital/phenytoin and improves long-term neurodevelopment.

2.Chin RFM, Verhulst L, Neville BGR, Peters MJ, Scott RC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neur Neurosurg Psych. 2004;75:1584–8.

The risk of respiratory depression is greater with more than two doses of benzodiazepines; clinicians should not disregard prehospital treatment of status epilepticus.

3.Alldredge BK, Gelb AM, Isaacs SM. A comparison of lorazepam, diazepam, and placebo for the treatment of out of hospital status epilepticus. N Engl J Med. 2001;345:631–7.

Benzodiazepines are safe and effective when administered by paramedics for out-of-hospital status epilepticus in adults. Lorazepam is likely to be a better therapy than diazepam.

4.Painter MJ, Scher MS, Stein AD, Armatti S, Wang Z, Gardiner JC, Paneth N, Minnigh B, Alvin J. Phenobarbital compared with phenytoin for the treatment of neonatal seizures. N Engl J Med. 2009;341(7):485–9.

Phenobarbital and phenytoin are equally but incompletely effective as anticonvulsants in neonates. With either drug given alone, the seizures were controlled in fewer than half of the neonates in this study.

5.Lowenstein DH, Bleck T, Macdonald RL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40:120–2.

6.Stecker MM, Kramer TH, Raps EC, O’Meeghan R, Dulaney E, Skaar DJ. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia. 1998;39(1): 18–26.

Propofol infusions can effectively and quickly terminate many but not all episodes of refractory status epilepticus. More studies are required to determine its true value in comparison with other agents.

7.Boylan GB, Rennie JM, Chorley G, Pressler RM, Fox GF, Farrer K, Morton M, Binnie CD. Second-line anticonvulsant treatment of neonatal seizures: a video-EEG monitoring study. Neurology. 2004;62(3):486–8.

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