Pathophysiology of convulsive status epilepticus

Seizure : the Journal of the British Epilepsy Association
Iván Sánchez FernándezRod C Scott

Abstract

To summarize the pathophysiology of convulsive status epilepticus (SE) with a focus on practical implications for treatment. Narrative review of the medical literature on the pathophysiology of convulsive SE. We considered both animal models of SE and clinical studies. Convulsive SE is an emergency in which prolonged convulsive seizures are associated with cardiorespiratory instability, hypoxia, hypoglycemia, and hyperthermia. Supportive treatment helps correct these physiological imbalances. When treatment is delayed, the ability of first line seizure suppressing medications to terminate the seizure can be reduced. Animal studies have suggested that GABAA receptor trafficking may contribute to the failure of the first line therapies and that NMDA receptor antagonists such as ketamine may become more effective as seizures last longer. Potential strategies to take advantage of these changes in pathophysiology include a rapid escalation from benzodiazepines to non-benzodiazepine antiepileptic drugs (AEDs), early polytherapy and use of NMDA antagonists such as ketamine for refractory convulsive SE. Despite the importance of a timely treatment of convulsive SE, major treatment delays are frequent in clinical practice. Policies to i...Continue Reading

Citations

Aug 26, 2020·Expert Opinion on Pharmacotherapy·Antonella RivaAlberto Verrotti
Aug 16, 2019·Neurochemical Research·Christoffer MertzLasse K Bak
Dec 28, 2019·CNS Drugs·Avantika SinghTobias Loddenkemper
Nov 12, 2020·Seminars in Neurology·Emily L Johnson, Peter W Kaplan
Mar 29, 2021·Resuscitation·Patrick Van de VoordeIan Maconochie
Jun 8, 2021·Notfall & Rettungsmedizin·Patrick Van de VoordeIan Maconochie

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