Pathophysiology of convulsive status epilepticus
Iván Sánchez Fernández1, Howard P Goodkin2, Rod C Scott3
1Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States; Department of Child Neurology, Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain.
Convulsive status epilepticus (SE) is a medical emergency. Understanding its pathophysiology can improve treatment, particularly by transitioning from benzodiazepines to other antiepileptic drugs (AEDs) to reduce resistance.
Area of Science:
- Neurology
- Emergency Medicine
- Pharmacology
Background:
- Convulsive status epilepticus (SE) is a prolonged seizure event.
- SE presents with significant physiological instability, including cardiorespiratory compromise and metabolic disturbances.
Purpose of the Study:
- To review the pathophysiology of convulsive SE.
- To identify practical treatment implications based on pathophysiological understanding.
Main Methods:
- A narrative review of existing medical literature.
- Inclusion of data from both animal models and human clinical studies of SE.
Main Results:
- Delayed treatment reduces the efficacy of first-line antiepileptic drugs (AEDs) in SE.
- Pathophysiological changes, such as GABA(A) receptor alterations, may explain treatment resistance.
- NMDA receptor antagonists like ketamine show potential for refractory SE.
Conclusions:
- Convulsive SE requires urgent intervention.
- Pathophysiological insights offer targets for enhanced SE treatment strategies.
- Early escalation to non-benzodiazepine AEDs can improve outcomes in SE.
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