Epilepsia
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Patients with status epilepticus that proves refractory to anesthetic agents represent a daunting challenge for treating clinicians. Animal data support the neuroprotective action of brain hypothermia, and its efficacy in status epilepticus models. ⋯ Conversely, mild hypothermia has a high-evidence level and is increasingly used in postanoxic encephalopathy, both in newborns and adults. Due to the paucity of available clinical data, prospective studies are needed to assess the value of hypothermia in status epilepticus.
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There is significant variability and controversy regarding the interpretation, nomenclature, and clinical implications of many EEG patterns seen in encephalopathic patients. The American Clinical Neurophysiology Society has attempted to create well-defined, objective rules for naming these patterns in order to allow scientific investigation into their significance. ⋯ A perfect system for describing complex wave forms with words will never be perfect; scalp EEG itself has substantial limitations, as intracranial recordings in neurocritical care patients have shown. The latest version of the nomenclature is available at http://www.acns.org.
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Current standard treatment of established status epilepticus after failure of benzodiazepines is intravenous phenytoin/fosphenytoin, phenobarbital, or valproate. Since 2006 two new antiseizure drugs have become available as intravenous formulation: levetiracetam (2006) and lacosamide (2008). ⋯ Future randomized controlled trials are needed to inform clinicians better about the best choice of treatment in established status epilepticus. The experimental evidence as well as the current clinical experience with levetiracetam and lacosamide are summarized in this review.