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Generalized Convulsive Status Epilepticus

      Generalized convulsive status epilepticus (GCSE) is a medical emergency that may be associated with severe neuronal injury. The mortality attributable to GCSE ranges from 3 to 35%. The disorder occurs most frequently in the young and the old extremes of the population. GCSE commonly occurs in patients with no history of seizures or epilepsy. The morbidity associated with status epilepticus is related to the underlying precipitating factors, age of the patient, and duration of seizure activity. Morbidity and mortality are highest in elderly patients and those with acute symptomatic seizures–for example, GCSE related to anoxia or cerebral infarction. Mortality is lowest among pediatric patients and patients with unprovoked seizures or GCSE related to low antiepileptic drug levels. Intravenously administered diazepam or lorazepam and phenytoin remain the first-line therapy for GCSE. More than half the patients will respond to initial treatment. Patients with refractory status epilepticus require a physician with expertise in epilepsy. Treatment options include pentobarbital, high-dose phenobarbital, or inhalation anesthetic agents.
      AED (antiepileptic drug), CT (computed tomographic), EEG (electroencephalographic), GCSE (generalized convulsive status epilepticus), MRI (magnetic resonance imaging)
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      References

        • Gastaut H
        Classification of status epilepticus.
        Adv Neurol. 1983; 34: 15-35
        • Engel JJI
        Seizures and Epilepsy. FA Davis,, Philadelphia1989: 256-280
        • Working Group on Status Epilepticus
        Treatment of convulsive status epilepticus: recommendations of the Epilepsy Foundation of America's Working Group on Status Epilepticus.
        JAMA. 1993; 270: 854-859
        • Hauser WA
        Status epilepticus: epidemiologic considerations.
        Neurology. 1990; 40: 9-13
        • Browne TR
        • Mikati M
        Status epilepticus.
        in: Ropper AH Kennedy SF Neurological and Neurosurgical Intensive Care. 2nd ed. Aspen Publishers,, Rockville (MD)1988: 269-288
        • Meldrum BS
        • Vigouroux RA
        • Brierley JB
        Systemic factors and epileptic brain damage: prolonged seizures in paralyzed, artificially ventilated baboons.
        Arch Neurol. 1973; 29: 82-87
        • Duffy TE
        • Howse DC
        • Plum F
        Cerebral energy metabolism during experimental status epilepticus.
        J Neurochem. 1975; 24: 925-934
        • Delgado-Escueta AV
        • Wasterlain C
        • Treiman DM
        • Porter RJ
        Status epilepticus: summary.
        Adv Neurol. 1983; 34: 537-541
        • Delgado-Escueta AV
        • Wasterlain C
        • Treiman DM
        • Porter RJ
        Current concepts in neurology: management of status epilepticus.
        N Engl J Med. 1982; 306: 1337-1340
        • Delgado-Escueta AV
        • Treiman DM
        Focal status epilepticus: modern concepts.
        in: Liiders H Lesser RP Epilepsy: Electroclinical Syndromes. Springer-Verlag,, New York1987: 347-391
        • Fountain NB
        • Lothman EW
        Pathophysiology of status epilepticus.
        J Clin Neurophysiol. 1995; 12: 326-342
        • Delorenzo RJ
        • Pellock JM
        • Towne AR
        • Boggs JG
        Epidemiology of status epilepticus.
        J Neurophysiol. 1995; 12: 316-325
        • Dodrill CB
        • Wilensky AJ
        Intellectual impairment as an outcome of status epilepticus.
        Neurology. 1990; 40: 23-27
        • Janz D
        Etiology of convulsive status epilepticus.
        Adv Neurol. 1983; 34: 47-54
        • Walker MC
        • Shorvon SD
        Treatment of status epilepticus and serial seizures.
        in: Shorvon S Dreifuss F Fish D Thomas D The Treatment of Epilepsy. Blackwell Science,, London1995: 269-285
        • Treiman DM
        The role of benzodiazepines in the management of status epilepticus.
        Neurology. 1990; 40: 32-42
        • Leppik IE
        • Derivan AT
        • Homan RW
        • Walker J
        • Ramsay RE
        • Patrick B
        Double-blind study of lorazepam and diazepam in status epilepticus.
        JAMA. 1983; 249: 1452-1454
        • Wilder BJ
        Efficacy of phenytoin in treatment of status epilepticus.
        Adv Neurol. 1983; 34: 441-446
        • Albani M
        How to use phenytoin.
        in: Morselli PL Pippenger CE Penry JK Antiepileptic Drug Therapy in Pediatrics. Raven Press,, New York1983: 253-262
      1. Status epilepticus: questions and answers.
        Neurology. 1990; 40: 47-51
        • Gabor AJ
        Lorazepam versus phenobarbital: candidates for drug of choice for treatment of status epilepticus.
        J Epilepsy. 1990; 3: 3-6
        • Simon RP
        • Copeland JR
        • Benowitz NL
        • Jacob III, P
        • Bronstein J
        Brain phenobarbital uptake during prolonged status epilepticus.
        J Cereb Blood Flow Metab. 1987; 7: 783-788
        • Snead III, OC
        • Miles MV
        Treatment of status epilepticus in children with rectal sodium valproate.
        J Pediatr. 1985; 106: 323-325
        • Dulac O
        • Aicardi J
        • Rey E
        • Olive G
        Blood levels of diazepam after single rectal administration in infants and children.
        J Pediatr. 1978; 93: 1039-1041
        • Goldberg MA
        • McIntyre HB
        Barbiturates in the treatment of status epilepticus.
        Adv Neurol. 1983; 34: 499-503
        • Van Ness PC
        Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin.
        Epilepsia. 1990; 31: 61-67
        • Young GB
        • Blume WT
        • Bolton CF
        • Warren KG
        Anesthetic barbiturates in refractory status epilepticus.
        Can J Neurol Sci. 1980; 7: 291-292
        • Young RS
        • Ropper AH
        • Hawkes D
        • Woods M
        • Yohn P
        Pentobarbital in refractory status epilepticus.
        Pediatr Pharmacol. 1983; 3: 63-67
        • Ropper AH
        • Kofke WA
        • Bromfield EB
        • Kennedy SK
        Comparison of isoflurane, halothane, and nitrous oxide in status epilepticus [letter].
        Ann Neurol. 1986; 19: 98-99
        • Crawford TO
        • Mitchell WG
        • Fishman LS
        • Snodgrass SR
        Very-high-dose phenobarbital for refractory status epilepticus in children.
        Neurology. 1988; 38: 1035-1040
        • Shorvon S
        Status Epilepticus: Its Clinical Features and Treatment in Children and Adults. Cambridge University Press, Cambridge (UK)1994: 175-292
        • MacKenzie SJ
        • Kapadia F
        • Grant IS
        Propofol infusion for control of status epilepticus.
        Anaesthesia. 1990; 45: 1043-1045
        • Dundee JW
        • Halliday NJ
        • Harper KW
        • Brogden RN
        Midazolam: a review of its pharmacological properties and therapeutic use.
        Drugs. 1984; 28: 519-543
        • Kuzniecky RI
        • Cascino GD
        • Palmini A
        • Jack Jr, CR
        • Berkovic SF
        • Jackson GD
        • et al.
        Structural neuroimaging.
        in: Engel Jr, J Surgical Treatment of the Epilepsies. 2nd ed. Raven Press,, New York1993: 197-209