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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(01): s00451801872
DOI: 10.1055/s-0045-1801872
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Treatment of convulsive status epilepticus in Brazil: a review

Luis Otavio Caboclo 
1   Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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Abstract

Status epilepticus (SE) is the most severe presentation of epilepsy. Currently, SE is defined according to 2 sequential time frames: time 1, after which it is unlikely that the seizure will resolve spontaneously, therefore requiring the initiation of therapy; and time 2, when long-term consequences become more likely. For convulsive SE, these time frames are well defined: 5 minutes for time 1 and 30 minutes for time 2. “Time is brain” in the treatment of SE, as delays in diagnosis and treatment are associated with worse outcomes. After clinical stabilization, the first step is the administration of intravenous (IV) benzodiazepines. Rapid initiation of treatment and use of appropriate dosing are more important than the selection of a specific benzodiazepine. Following this, treatment continues with the use of an IV antiseizure medication (ASM). In Brazil, the recommended options available are phenytoin and levetiracetam. Status epilepticus is considered refractory to treatment if seizures persist after the administration of benzodiazepines and IV ASM. The cornerstone of this stage is the induction of therapeutic coma using IV anesthetic drugs (IVADs), although evidence is limited regarding the choice among midazolam, propofol, or barbiturates. Super-refractory SE is defined when seizures persist despite continuous infusion of IVADs or recur after these drugs are tapered. There is very limited data regarding the treatment of super-refractory SE. In the absence of randomized controlled trials, treatment should be guided by the physician's experience, clinical judgment, and established therapeutic options from previous reports.

Keywords

Status Epilepticus - Refractory - Super-Refractory - Antiseizure Medications

Editor-in-Chief: Ayrton Roberto Massaro.


Associate Editor: Hélio A. G. Teive.




Publication History

Received: 11 November 2024

Accepted: 10 December 2024

Article published online:
11 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Luis Otavio Caboclo. Treatment of convulsive status epilepticus in Brazil: a review. Arq Neuropsiquiatr 2025; 83: s00451801872.
DOI: 10.1055/s-0045-1801872
 

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