From the Guidelines
The prognosis for return to normal after status epilepticus is generally favorable, with approximately half of all patients achieving cessation of seizures with the use of levetiracetam, fosphenytoin, or valproate, as evidenced by the most recent study 1. The outcome is not influenced by the patient’s home medications or age, and the benefit of early treatment and cessation of status epilepticus is a reduction in morbidity and mortality. Key factors in determining the prognosis include:
- The severity and underlying cause of the status epilepticus
- The promptness and effectiveness of treatment
- The presence of any underlying neurological or medical conditions
- The patient’s overall health and resilience In terms of treatment, the use of benzodiazepines such as lorazepam or midazolam as first-line therapy, followed by anti-seizure medications like fosphenytoin, valproate, or levetiracetam, is recommended 1. It is also important to note that valproate has been shown to be at least as effective as phenytoin for refractory status epilepticus, with potentially fewer adverse effects, as demonstrated in previous studies 1. However, the most recent and highest quality study 1 takes precedence in guiding treatment decisions. Overall, the goal of treatment is to rapidly control seizures, manage any underlying conditions, and support the patient’s recovery, with the aim of minimizing morbidity and mortality, and optimizing quality of life.
From the Research
Prognosis for Return to Normal after Status Epilepticus
The prognosis for return to normal after status epilepticus (SE) is influenced by several factors, including the duration of SE, etiology, and promptness of treatment.
- The duration of SE is a significant predictor of outcome, with shorter durations associated with better outcomes 2.
- However, the influence of duration on outcome diminishes after several hours, and etiology becomes the primary determinant of outcome 2.
- Prompt recognition and targeted therapy can reduce the risk of complications and death associated with SE, thereby improving outcomes 3.
Factors Influencing Prognosis
Several factors can influence the prognosis for return to normal after SE, including:
- Etiology: SE caused by anoxia/hypoxia has a poorer prognosis than SE caused by epilepsy or other etiologies 2.
- Presentation in coma: Patients who present in coma have a poorer prognosis than those who do not 2.
- Type of SE: Focal SE may have a different prognosis than generalized SE 2.
- Use of benzodiazepines: Benzodiazepines are the first-line treatment for SE, and their use can influence outcome 4, 5.
Treatment and Outcome
Effective clinical management of SE requires rapid initiation of supportive measures, assessment of the cause of the seizure, and first-line treatment with benzodiazepines 3.
- If SE continues, management should entail second-line and third-line treatment agents, supportive EEG monitoring, and admission to an intensive care unit 3.
- The use of levetiracetam as a second-line antiepileptic drug has been shown to be effective in terminating seizures in children with SE 6.
- Benzodiazepines are often underdosed and underused in the treatment of SE, particularly in patients with nonconvulsive status epilepticus (NCSE) 5.