Diagnosis and treatment of status epilepticus

Abstract

Status epilepticus (SE) is a common neurological emergency with high morbidity and mortality. Prompt and appropriate diagnosis and treatment of SE lead to a good outcome. We outline in this review the definition and classification, diagnosis, and treatment of SE according to the up–to–date knowledge. The International League Against Epilepsy's new definition and classification of SE in 2015 are explained. Although the diagnosis of convulsive SE is mostly easy, there are some pitfalls (e.g., psychogenic non–epileptic seizure). As the symptoms of nonconvulsive SE (NCSE) are various and nonspecific, electroencephalography findings are essential for its diagnosis. The Salzburg criteria are now widely used as the diagnostic criteria for NCSE, and its high diagnostic accuracy and excellent inter–rater agreement were reported. Although a number of treatment guidelines for convulsive SE have been published in recent years, the basic concept of treatment strategy is similar : benzodiazepines as the first–line, intravenous antiepileptic drugs as the second–line, and anesthetics as the third–line drugs. However, evidence for the second and third–line drugs is insufficient to date. Furthermore, only an expert opinion is available for the treatment of NCSE.