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Treating epileptic emergencies - pharmacological advances

Journal article
Authors Johan Zelano
Elinor Ben-Menachem
Published in Expert Opinion on Pharmacotherapy
Volume 17
Issue 16
Pages 2227-2234
ISSN 1465-6566
Publication year 2016
Published at Institute of Neuroscience and Physiology
Pages 2227-2234
Language en
Keywords Status epilepticus, epileptic emergency, side effects of anti-seizure drugs, seizure clusters, convulsive status epilepticus, acute repetitive seizures, antiepileptic, drugs, intravenous valproate, refractory epilepsy, double-blind, levetiracetam, phenytoin, lacosamide, safety, Pharmacology & Pharmacy
Subject categories Pharmacology, Clinical pharmacology


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(nd) line drug after the failure of valproate, fosphenytoin and levetiracetam. Our review underlines the need for more research in management of epileptic emergencies.

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