How to manage acute symptomatic seizures and status epilepticus

Abstract

Acute symptomatic seizures (ASS) and status epilepticus (SE) are common neurological emergencies. The definitions of ASS and SE and relationship between them should be understood to manage them appropriately. In this review, the definitions, epidemiology, relationship, and management strategy of ASS and SE are outlined. Importantly, seizures are classified into ASS and unprovoked seizures. ASS accounts for 55% of all seizures. While both ASS and unprovoked seizures can cause SE, ASS accounts for 50–87% of all SE. Therefore, we should differentiate ASS in most cases of seizures and SE. In patients with ASS, underlying etiologies must be treated, and further seizures be prevented according to the risk of seizure recurrence. The decision to start antiseizure medications, their choice, and treatment duration should be individualized with no clear guidelines available. In patients with SE, ongoing seizures must be stopped as soon as possible in parallel with the differentiation of ASS. SE should be treated in accordance with the treatment guidelines published in the US, Europe, and Japan : benzodiazepines as the first–line, intravenous antiepileptic drugs as the second–line, and anesthetics as the third–line drugs. When anesthetics are used, continuous electroencephalogram monitoring is recommended to monitor the level of sedation, assess the efficacy of treatment, and diagnose nonconvulsive seizures and nonconvulsive SE.