PMID- 33830480
OWN - NLM
STAT- MEDLINE
DCOM- 20211115
LR  - 20211115
IS  - 1179-1950 (Electronic)
IS  - 0012-6667 (Linking)
VI  - 81
IP  - 7
DP  - 2021 May
TI  - Pharmacotherapy for Nonconvulsive Seizures and Nonconvulsive Status Epilepticus.
PG  - 749-770
LID - 10.1007/s40265-021-01502-4 [doi]
AB  - Most seizures in critically ill patients are nonconvulsive. A significant number 
      of neurological and medical conditions can be complicated by nonconvulsive 
      seizures (NCSs) and nonconvulsive status epilepticus (NCSE), with brain 
      infections, hemorrhages, global hypoxia, sepsis, and recent neurosurgery being 
      the most prominent etiologies. Prolonged NCSs and NCSE can lead to adverse 
      neurological outcomes. Early recognition requires a high degree of suspicion and 
      rapid and appropriate duration of continuous electroencephalogram (cEEG) 
      monitoring. Although high quality research evaluating treatment with antiseizure 
      medications and long-term outcome is still lacking, it is probable that 
      expeditious pharmacological management of NCSs and NCSE may prevent 
      refractoriness and further neurological injury. There is limited evidence on 
      pharmacotherapy for NCSs and NCSE, although a few clinical trials encompassing 
      both convulsive and NCSE have demonstrated similar efficacy of different 
      intravenous (IV) antiseizure medications (ASMs), including levetiracetam, 
      valproate, lacosamide and fosphenytoin. The choice of specific ASMs lies on 
      tolerability and safety since critically ill patients frequently have impaired 
      renal and/or hepatic function as well as hematological/hemodynamic lability. 
      Treatment frequently requires more than one ASM and occasionally escalation to IV 
      anesthetic drugs. When multiple ASMs are required, combining different mechanisms 
      of action should be considered. There are several enteral ASMs that could be used 
      when IV ASM options have been exhausted. Refractory NCSE is not uncommon, and its 
      treatment requires a very judicious selection of ASMs aiming at reducing seizure 
      burden along with management of the underlying condition.
FAU - Bravo, Pablo
AU  - Bravo P
AUID- ORCID: 0000-0001-7049-6484
AD  - Comprehensive Epilepsy Center, Department of Neurology, Yale University School of 
      Medicine, New Haven, CT, USA.
FAU - Vaddiparti, Aparna
AU  - Vaddiparti A
AUID- ORCID: 0000-0002-1709-4440
AD  - Comprehensive Epilepsy Center, Department of Neurology, Yale University School of 
      Medicine, New Haven, CT, USA.
FAU - Hirsch, Lawrence J
AU  - Hirsch LJ
AUID- ORCID: 0000-0002-6333-832X
AD  - Comprehensive Epilepsy Center, Department of Neurology, Yale University School of 
      Medicine, New Haven, CT, USA. lawrence.hirsch@yale.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210408
PL  - New Zealand
TA  - Drugs
JT  - Drugs
JID - 7600076
RN  - 0 (Anesthetics, Intravenous)
RN  - 0 (Anticonvulsants)
RN  - 0 (Drug Combinations)
SB  - IM
MH  - Anesthetics, Intravenous/therapeutic use
MH  - Animals
MH  - Anticonvulsants/administration & dosage/adverse effects/*therapeutic use
MH  - Brain/physiopathology
MH  - *Critical Illness
MH  - Drug Combinations
MH  - Electroencephalography
MH  - Humans
MH  - Kidney Function Tests
MH  - Liver Function Tests
MH  - Seizures/diagnosis/*drug therapy
MH  - Status Epilepticus/diagnosis/drug therapy
MH  - Time Factors
EDAT- 2021/04/09 06:00
MHDA- 2021/11/16 06:00
CRDT- 2021/04/08 12:49
PHST- 2021/03/13 00:00 [accepted]
PHST- 2021/04/09 06:00 [pubmed]
PHST- 2021/11/16 06:00 [medline]
PHST- 2021/04/08 12:49 [entrez]
AID - 10.1007/s40265-021-01502-4 [pii]
AID - 10.1007/s40265-021-01502-4 [doi]
PST - ppublish
SO  - Drugs. 2021 May;81(7):749-770. doi: 10.1007/s40265-021-01502-4. Epub 2021 Apr 8.