Abstract

HERNANDEZ ORTIZ, Olga Helena et al. Refractory status epilepticus in Instituto Neurológico de Antioquia - intensive care unit a management algorithm. Acta Neurol Colomb. [online]. 2011, vol.27, n.1, pp.33-45. ISSN 0120-8748.

Status Epilepticus (SE) is a medical emergency, due to significant morbidity and mortality. In the Intensive Care Unit (ICU) there are two groups of patients with SE: patients with multiple episodes of seizures that are non-responsive to initial management and there are individuals admitted for other reasons who developed non convulsive status epilepticus (NCSE) subclinical ictal episodes in their ICU permanence. It is estimated NCSE represents between 25-50% of the SE, but in the critically-ill patient this entity could have a greater incidence. 10 to 40% of all patients with SE evolve to a refractory status epilepticus (RSE). Refractory status epilepticus (RSE) is defined as the absence of response to a first-line antiepileptic drug (benzodiazepines) and to one or two second-line drugs. Control of RSE demands the use of multiple anticonvulsant drugs (AED), high-dose sedatives, and sometimes vasopressive or mechanical ventilatory support. RSE management is based on case reports and experience from referral centers. It is recommended that the elimination of electrographic ictal activity is conducted through sedation, reaching a pharmacological burst-suppression pattern; a less aggressive alternative is suggested, without sedation, using antiepileptic medication in high-doses, in a step-up approach, guided by the improvement observed through cVEEG monitoring. The purpose of this study is to present recommendations for management of RSE in critically ill patients based on current literature and experience in the ICU of the Neurological Institute of Antioquia (INDEA).

Keywords : Status Epilepticus; Epilepsy; Neurology.

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