Updates in the Management of Status Epilepticus in the Emergency Department: a Review of Evidence-based Guidelines and Novel Agents
Year: 2025
Type: article
Abstract: Status epilepticus (SE) is a critical neurological emergency requiring urgent, evidence-based management to mitigate high morbidity and mortality. This systematic review synthesizes current evidence and guidelines on the emergency treatment of SE, focusing on recent pharmacological advances. A comprehensive literature search was conducted per PRISMA guidelines across major databases from 2000-2024. The review included RCTs, systematic reviews, and clinical guidelines, with quality assessed via tools like Cochrane RoB 2 and AGREE II. From 2,189 records, 18 studies were included. Findings robustly confirm benzodiazepines as first-line therapy. The practice-changing ESETT trial established "three-drug equipoise" for second-line treatment, demonstrating equivalent efficacy and safety for levetiracetam, fosphenytoin, and valproate. For refractory SE, ketamine emerges as a key third-line agent, with a 63% seizure cessation rate and a favorable hemodynamic profile. Novel agents like brivaracetam, perampanel, and allopregnanolone offer promise for super-refractory cases. Major guidelines consistently endorse a time-sensitive, staged treatment algorithm. In conclusion, emergency SE management is evolving toward protocol-driven care emphasizing rapid benzodiazepine administration, flexible second-line agent selection, and the early use of ketamine. Future research must prioritize RCTs in super-refractory SE and investigate long-term functional outcomes. Keywords: Status Epilepticus, Emergency Treatment, Refractory Status Epilepticus, Levetiracetam, Ketamine.
Author: Dubyyan Sati Alshaibani, Fahad Salem Alfaifi, Faisal Abdullah Alzamil, Ali Mohammed Othman Al Zamil, Omar Jazi bin Falah Almutairi, Bader Daher Alotaibi, Tariq Fayeh Alotaibi, Majed Ayedh Alotaibi, Nawaf Saad Al Otabe, Nasser Abdulmohsen Alwatban
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7089413121
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