scholarly journals Fosphenytoin for the treatment of status epilepticus: an evidence-based assessment of its clinical and economic outcomes

Core Evidence ◽  
2005 ◽  
Vol Volume 1-Issues 1 & 2 ◽  
pp. 0-0
Author(s):  
Core Journal
Keyword(s):  
Status Epilepticus ◽  
Economic Outcomes ◽  
Evidence Based

scholarly journals The Treatment and Prognosis of Refractory and Super-Refractory Status Epilepticus

2017 ◽  
Vol 01 (03) ◽  
pp. E204-E210
Author(s):  
Stephanie Gollwitzer ◽  
Hajo Hamer
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Evidence Based ◽  
New Approach ◽  
Refractory Status ◽  
First Choice ◽  
Evidence Based Guidelines

AbstractRefractory status epilepticus (RSE) is defined as status epilepticus (SE) persisting over 60 min and resistant to treatment with benzodiazepines and non-sedating antiepileptic drugs. The term super-refractory status epilepticus (SRSE) refers to a refractory episode continuing under general anesthesia for more than 24 h. RSE is treated with a combination of non-sedating AED and i. v. anesthetics; first choice drugs are midazolam, propofol and thiopental. The management of super-refractory status epilepticus (SRSE) is challenging as clear evidence-based guidelines are lacking. Recommendations are mainly based on case reports and small case series. Therapeutic options include ketamine, inhalational anesthetics, steroids and immunoglobulins. Ketogenic diet, electroconvulsive therapy and epilepsy surgery are also considered as potentially effective. A promising new approach is the neurosteroid allopregnanolone. Mortality of RSE and SRSE is largely influenced by the etiology and is markedly higher as compared to non-refractory status epilepticus. It was reported to be about 30% and 50%, respectively.

scholarly journals Status Epilepticus: The Slow and Agonizing Death of Phenytoin

2020 ◽  
Vol 25 (1) ◽  
pp. 4-6 ◽  
Author(s):  
Elizabeth A. Hall ◽  
James W. Wheless ◽  
Stephanie J. Phelps
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Drug Interactions ◽  
Mechanism Of Action ◽  
Adult Patients ◽  
Evidence Based ◽  
Insufficient Evidence ◽  
First Line ◽  
Acute Seizures ◽  
Acute Seizure

Since its introduction in 1950, phenytoin (PHT) has been the premier parenteral anticonvulsant used in the management of generalized convulsive status epileptics (GCSE) that is refractory to benzodiazepines. Without question, its arrival was vital to the care of patients with acute seizures and was a welcomed alternative to paraldehyde and phenobarbital. However, after more than half a century of use, there continues to be insufficient evidence-based data to support its efficacy over other anticonvulsants as a first-line agent in pediatric or adult patients with GCSE. This coupled with its narrow mechanism of action, complex pharmacokinetics and pharmacogenomics, drug-drug interactions, unique adverse effects, and formulation issues that make administration difficult mandates that PHT be replaced by safer and superiorly effective anticonvulsants for the treatment of GCSE when benzodiazepines are ineffective. We believe that levetiracetam should become the preferred agent for seizures unresponsive to or recurring after treatment with a benzodiazepine as it is at least equally effective to PHT and has several important advantages. PHT has overstayed its welcome and it is simply time for it to exit the realm of acute seizure management as a first-line agent for benzodiazepine-refractory GCSE.

scholarly journals Economic outcomes and levers: impacts for individuals and society

2007 ◽  
Vol 19 (3) ◽  
pp. 483-495 ◽  
Author(s):  
Martin Knapp
Keyword(s):  
Full Range ◽  
Decision Makers ◽  
Economic Outcomes ◽  
Evidence Based ◽  
Economic Evidence ◽  
Economic Barriers ◽  
Barriers To Implementation ◽  
Care And Treatment ◽  
Scarcity Of Resources ◽  
Generic Measures

The pervasive scarcity of resources relative to the demands upon them makes it necessary for decision makers to think carefully about choices. Evidence from economics can help to inform such choices, particularly as it relates to costs, outcomes, the efficiency with which resources are used, the distribution of benefits and burdens across different individuals and budgets, and the processes by which care and treatment are delivered. However, there is still insufficient economic evidence to inform the full range of decisions to be taken in the dementia field; indeed the accumulated volume of evidence remains very modest. The measurement of cost is often too narrow, and there is some disagreement about whether and how to include the costs (direct or indirect) incurred by caregivers. The conceptualization of outcomes for certain purposes has generated argument, especially when attempts are made to introduce generic measures that apply across many clinical areas. It has not always been demonstrated that such measures have any validity in the dementia field. Other comparatively neglected areas have been research on equity and the processes by which care is delivered. Finally, the paper looks at economic barriers to implementation of evidence-based interventions, and the policy levers that might prove influential.

scholarly journals Progress in Clinical Neurosciences: Status Epilepticus: A Critical Review of Management Options

2002 ◽  
Vol 29 (3) ◽  
pp. 206-215 ◽  
Author(s):  
Eelco F.M. Wijdicks ◽  
Nicholas D. Lawn
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Critical Review ◽  
Critical Appraisal ◽  
Management Strategies ◽  
Individual Preference ◽  
Evidence Based ◽  
Management Options ◽  
Local Hospital ◽  
Expert Recommendations

Although generalized tonic-clonic status epilepticus (SE) is frequently seen, an evidence-based approach to management is limited by a lack of randomized clinical studies. Clinical practice, therefore, relies on a combination of expert recommendations, local hospital guidelines and dogma based on individual preference and past successes. This review explores selected and controversial aspects of SE in adults and provides a critical appraisal of currently recommended management strategies.

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