Diagnosis and treatment of status epilepticus on a neurological intensive care unit

Status epilepticus refractory to first-line therapy is associated with ahigh morbidity and mortality. Correct diagnosis and adequate treatment ofthis condition require electrographic monitoring and anaesthetic facilitiesavailable in specialist intensive care units (ICUs). We carried out anaudit of 26 patients admitted to a neurological ICU with a diagnosis ofstatus epilepticus, to identify deficiencies in diagnosis and managementprior to transfer to the ICU, and examine the effectiveness of ICUmanagement. Or transfer, only 14 (54%) were in status epilepticus; six werein drug-induced coma or were encephalopathic, and six had pseudostatusepilepticus, of whom four had been intubated. The commonest treatmentsprior to transfer were benzodiazepines, chlormethiazole and phenytoin; theloading dose of phenytoin was adequate in at least 7/16 cases. All those instatus epilepticus on transfer had their seizures successfully controlled,but ten required general anaesthesia with thiopentone, propofol, ketamineor midazolam. Two died--one had a severe encephalitis and the other had hada cardiac arrest prior to treatment. This study highlights deficiencies inthe initial diagnosis and management of status epilepticus, the role ofspecialist neurological intensive care, and the importance of earlyreferral.