Three medications have been found that safely treat refractory status epilepticus, which is a disorder in which seizures continue even after being treated with common medication. Benzodiazepene medications, medications that work for two-thirds of patients, do not effectively treat people with this disorder, making their seizures more dangerous. This danger is what makes the discovery of new treatments so important. These new drugs, levetiracetam, fosphenytoin, and valproate, are all safe for treatment of those with refractory status epilepticus.
About Refractory Status Epilepticus
Refractory status epilepticus is a form of status epilepticus characterized by seizures that continue after treatment of benzodiazepenes. Status epilepticus is a rare and possibly fatal condition characterized by seizures that are nonstop and last for five minutes or longer or more than one seizure in this time period without regaining consciousness. This condition does not affect the majority of people with epilepsy, but this medical emergency does tend to affect young children or the elderly. It is estimated that there are about 150,000 cases every year in the U.S., which translates to about 55,000 fatalities. Without medical intervention, SE can result in permanent damage to the body and brain or even death.
Symptoms of SE include recurring seizures without regaining consciousness, seizures lasting five minutes or longer, loss of consciousness, falling, clenched jaw, jerking and clinching muscle spasms, unusual breathing, inability to speak, “far-off” look or staring, and a lack of control of the bladder and bowels. After these symptoms are noticed, doctors will conduct a full examination.
In terms of treatment, it is very important that swift medical intervention occurs. Doctors will immediately treat the seizure itself while also trying to find out the underlying cause. Treatments include glucose for low blood pressure, oxygen, lorazepam, diazepam, phenobarbital, valproate, and fosphenytoin. There are also methods that help to reduce the severity and frequency of SE. These methods include a prescribed treatment plan that may include anti-seizure medication, rest and sleep, reducing stress, avoiding alcohol, a special diet, and monitoring blood sugar. It is strongly recommended that people with SE seek treatment from an epileptologist.
About Levetiracetam, Fosphenytoin, and Valproate
These drugs were found to effectively treat people with refractory status epilepticus. A study was conducted in order to evaluate the safety and effectiveness of these drugs, and the findings were published in the New England Journal of Medicine. The National Institutes of Health (NIH) also supported this study. The Established Status Epilepticus Treatment Trial (ESETT) was conducted with more than 380 children and adults who received one of these drugs upon coming to the emergency room for treatment. The goal of the study was to determine which of the drugs was the most effective within 60 minutes of administering it. They did so by evaluating which was the best at stopping the seizure and improving responsiveness. Researchers concluded that the three drugs were effective in approximately half of patients. Levetiracetam was effective in 47% of patients, with fosphenytion at 45%, and valproate at 46%. In terms of side effects, all three drugs had no differences in serious side effects.
Future of Treatment
The researchers who conducted this study were also focused on the overall treatment of SE. They found that outcomes of SE can be more affected by how doctors choose to treat their patients, such as the timing of dosages, anesthesia, and putting patients on ventilators. They found that this may be more important than the actual medication chosen to treat patients. In terms of the drugs studied, the researchers stated that “doctors can be confident that the particular treatment they choose for their patients with status epilepticus is safe and effective.”
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