Status epilepticus has become a severe public health problem in the United States. The epilepticus achieved the status based on its association with its contingent that the individual displays before the initial treatment, the age of the patient, and the condition. When left untreated, status epilepticus becomes life-threatening, and in fact, it has a high mortality rate in comparison to other epileptic attacks.
What Is Used To Treat Status Epilepticus?
With the evolution of technology in the medical field, scientists introduced new medications that are helpful in treating status epilepticus – rectal diazepam, fosphenytoin, and parenteral valproate. All the three treatment procedures have implications for managing the status epilepticus.
Although the new line of medicines is available, many of the neurologists still opt for benzodiazepines as the first line of treatment in curing and managing status epilepticus. The reason behind choosing benzodiazepines over the three medications is that it is vital to bring down the situation under control by suppressing the seizure. If the patient does not receive immediate attention or treatment using the available drugs, he or she will show no sign of improvement, which leads to death.
Pharmacology Management to Treat Status Epilepticus
Treating status epilepticus instantaneously is essential to prevent systemic and neurology pathology. As always, it is necessary for the neurologist to diagnose and terminate the seizure immediately. For termination, it is essential for the clinician to use the drug as intravenously to gain quick access to the brain without posing a serious risk of causing adverse neurological effects. Several medications are available that the doctor can inject intravenously, where every drug has a particular advantage and disadvantage.
Benzodiazepines to Treat Status Epilepticus
Benzodiazepines are the most effective drugs for treating status epilepticus. The commonly used drugs are lorazepam, midazolam, and diazepam. Out of all the three drugs, diazepam is the first in line for managing status epilepticus. It redistributes to the entire brain in 15 minutes from the point of injection even though it has high lipid solubility. Due to this, there is a reduction in its clinical effect.
Diazepam to Treat Status Epilepticus
Regardless of this, clinicians introduce diazepam into the patient suffering from a seizure about 10 mg for every minute to suppress status epilepticus. Considering the statistics, about 75% of patients responded positively, and the emergency team was able to bring down the patients under control. However, the drug does have side effects that include respiratory suppression, local tissue irritation, and hypotension. It is possible to co-administer both hypotension and respiratory suppression with the use of additional antiepileptic drugs. It is also possible for the medical team to introduce diazepam into the patient as rectally and intramuscularly.
Lorazepam to Treat Status Epilepticus
In order to treat acute management of status epilepticus, clinicians or neurologists often prefer lorazepam. When compared with diazepam, lorazepam differs in two different aspects. The critical point is that it is less lipid soluble and remains up to 3 hours when compared with that of 15 minutes of diazepam. Therefore, it provides longer duration of clinical effect. Additionally, it binds the receptor with enhanced tightness than diazepam to provide an extended period of action.
The typical dose ranges between four and eight milligrams. The drug is capable of curing around 80 percent of cases, with similar signs of side effects as that of diazepam.
Midazolam to Treat Status Epilepticus
Although rarely used as the first choice in the United States, midazolam stands fast in curing status epilepticus in Europe. It too provides the needed requirement in order to treat status epilepticus. When compared with diazepam and lorazepam, midazolam stands out because of its action against the receptors and the response it shows in treating the patients.
“Treatment of Convulsive Status Epilepticus” – American Epilepsy Society Guidelines: https://www.aesnet.org/sites/default/files/file_attach/convulsivestatusfinal.pdf
“Status Epilepticus: An Overview” – Cleveland Clinic Article: https://my.clevelandclinic.org/health/diseases/9832-status-epilepticus
“Status Epilepticus: Diagnosis and Management” – American Family Physician Article: https://www.aafp.org/afp/2017/0415/p441.html
“Status Epilepticus: A Review” – National Center for Biotechnology Information Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101959/
“Seizures and Epilepsy: Hope Through Research” – National Institute of Neurological Disorders and Stroke (NINDS) Article: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Epilepsies-and-Seizures-Hope-Through