Current Treatment for Generalized Convulsive Status Epilepticus in Adults.

Status epilepticus (SE) is defined as a seizure lasting longer than 5 min, or at least two seizures without full recovery of consciousness between them. Early emergent medical management consists of life support and an etiology survey, and subsequent treatment can be classified into 4 stages: (1) early SE, (2) established SE, (3) refractory SE, and (4) super-refractory SE. For early SE, benzodiazepines, such as lorazepam and diazepam, are the agents of choice, given to terminate the seizure activity rapidly. For established SE (20-30 min after SE onset), the therapeutic strategy is to give parental antiepileptic drugs, such as phenytoin, valproic acid, and levetiracetam. At the stage of refractory SE (1-2 hours after SE onset), the conventional treatment is induction of general anesthesia using midazolam or propofol. Superrefractory SE is defined as SE that continues, or recurs, for at least 24 hours after the onset of anesthetic therapy. In addition to treatments used in established and refractory SE, other potentially effective therapies include ketamine, magnesium, inhalational anesthetics, immunotherapy, ketogenic diet, induced hypothermia, and neurosurgery. The principle of SE therapy is rapid seizure control and correction of underlying problems. Future well-designed clinical trials are mandatory to establish the standard treatment, especially in settings of established, refractory, and super-refractory SE.