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Volume : 26  Issue : 2  Year: 2020

Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy [Epilepsi]
Epilepsi. 2007; 13(2): 97-105

Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy

Fabio Miniccuci1, Giancarlo Muscas2, Emilio Perucca3, Giuseppe Capovılla4, Federico Vigevano5, Paolo Tinuper6
1Clinical Neurophysiology, San Raffaele Hospital, Milan
2Epilepsy Center, Department Of Neurology, Careggi Hospital, Florence
3Institute Of Neurology, Irccs C. Mondino Foundation And Clinical Pharmacology Unit, University Of Pavia, Pavia
4Department Of Child Neuropsychiatry, C. Poma Hospital, Mantova
5Neurology Division, Bambino Gesu Children’s Hospital, Rome
6Department Of Neurological Sciences, University Of Bologna, Bologna, Italy

Status epilepticus (SE) is a medical emergency which can lead to significant morbidity and mortality and requires prompt diagnosis and treatment. SE is differentiated into generalized or partial SE on the basis of its electro-clinical manifestations. The guidelines for the management of SE produced by the Italian League against Epilepsy also distinguish three different stages of SE (initial, established and refractory), based on time elapsed since the onset of the condition and responsiveness to previously administered drugs. Treatment should be started as soon as possible, particularly in generalized convulsive SE, and should include general support measures, drugs to suppress epileptic activity and, whenever possible, treatments aimed at relieving the underlying (causative) condition. Benzodiazepines are the first line antiepileptic agents, and i.v. lorazepam is generally preferred because it is associated with a lower risk of early relapses. If benzodiazepines fail to control seizures, i.v. phenytoin is usually indicated, though i.v. phenobarbital or i.v. valproate may also be considered. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity.In refractory SE, general anesthesia may be required. Propofol and thiopental represent
first line agents in this setting, after careful assessment of potential risks and benefits.

Keywords: Status epilepticus, epilepsy, treatment, antiepileptic drugs, guidelines, Italian league against epilepsy


Yetişkinlerde Status Epileptikus Tedavisi: İtalyan Epilepsi Ligi Kılavuzu

Fabio Miniccuci1, Giancarlo Muscas2, Emilio Perucca3, Giuseppe Capovılla4, Federico Vigevano5, Paolo Tinuper6
1Clinical Neurophysiology, San Raffaele Hospital, Milan
2Epilepsy Center, Department Of Neurology, Careggi Hospital, Florence
3Institute Of Neurology, Irccs C. Mondino Foundation And Clinical Pharmacology Unit, University Of Pavia, Pavia
4Department Of Child Neuropsychiatry, C. Poma Hospital, Mantova
5Neurology Division, Bambino Gesu Children’s Hospital, Rome
6Department Of Neurological Sciences, University Of Bologna, Bologna, Italy

Status epileptikus (SE) belirgin morbidite ve mortaliteye neden olabilen ve hızlı tanı ve tedavi gerektiren medikal acil bir durumdur. SE elektro - klinik bulgulara dayalı olarak jenaralize ve parsiyel SE olarak tanımlanmaktadır.İtalyan Epilepsi Ligi Kılavuzu ayrıca SE'nin 3 farklı evresini (başlangıç, ilerlemiş, refrakter) durumun gelişmesinden itibaren geçen süre ve verilen ilaçlara karşı yanıt duruma dayalı olarak tanımlamıştır. Tedavi özellikle jeneralize konvulsif SE' da olabildiğince hızlı başlamalı ve genel destek önlemleri, epileptik aktiviteyi baskılayan ilaçlar ve mümkünse altta yatan durumun düzeltilmesini hedefleyen yaklaşımları içermelidir. Benzodiazepinler ilk seçenek antiepileptik ilaçlardır ve i.v lorezapam, daha düşük erken relaps riski nedeniyle genel olarak tercih edilir. Eğer benzodiazepinler nöbetin kontrolünde başarısız olursa, genellikle i.v. fenitoin endikedir ama i.v fenorbital veya i.v valproat da göz önünde tutulabilir. Retrakter SE, uygun izlem ve respiratuvar, metabolik ve hemodinamik fonksiyonların desteklenmesi ve serebral elektriksel aktivitenin izlenmesi için yoğun bakım ünitesine (YBÜ) başvuru gerektirebilir.Retrakter SE'da, genel anestezi gerekebilir. Risk ve yararlar dikkatle değerlendirildikten sonra propofol ve tiopental bu durumda ilk seçenek ajanlardır.

Anahtar Kelimeler: Status epileptikus, epilepsi, tedavi, antiepileptik ilaçlar, kılavuz, İtalyan epilepsi ligi


Fabio Miniccuci, Giancarlo Muscas, Emilio Perucca, Giuseppe Capovılla, Federico Vigevano, Paolo Tinuper. Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy. Epilepsi. 2007; 13(2): 97-105

Corresponding Author: Fabio Miniccuci


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