Expert Opin Pharmacother. 2016 Nov;17(16):2227-2234. doi: 10.1080/14656566.2016.1241236. Epub 2016 Oct 14.
Treating epileptic emergencies - pharmacological advances.
Expert opinion on pharmacotherapy
Johan Zelano, Elinor Ben-Menachem
Affiliations
Affiliations
- a Department of Clinical Neuroscience and Department of Neurology, Sahlgrenska Academy , University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.
PMID: 27686410
DOI: 10.1080/14656566.2016.1241236
Abstract
INTRODUCTION: Epileptic emergencies are frequently encountered and include ictal events as status epilepticus or seizure clusters, and non-ictal situations like postictal psychosis or acute drug side effects. The aim of this review was to describe recent pharmacological advances in the treatment of epileptic emergencies. Areas covered: Based on clinically relevant questions, a literature search was performed. The search showed that most pharmacological advances have been made in management of status epilepticus, where substantial literature has accumulated on several AEDs with potentially less side-effects than the traditional choices. The use of these drugs; valproate, levetiracetam, and lacosamide, was therefore made the main focus of this review. Pharmacological advances in treatment of other epileptic emergencies were scarce, and were therefore covered more briefly in the Expert Opinion section. Expert opinion: This section outlines our current practice in management of status epilepticus and seizures clusters. Our opinion is that valproate is an equal alternative as second line treatment to fosphenytoin, with levetiracetam considered a good choice in frail and elderly patients. Due to the lack of literature, lacosamide is used mainly as a 2
Keywords: Status epilepticus; epileptic emergency; seizure clusters; side effects of anti-seizure drugs
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