DIAGNOSIS AND TREATMENT OF STATUS EPILEPTICUS ON A NEUROLOGICAL INTENSIVE-CARE UNIT

Status epilepticus refractory to first-line therapy is associated with a high morbidity and mortality. Correct diagnosis and adequate treatm ent of this condition require electrographic monitoring and anaestheti c facilities available in specialist intensive care units (ICUs) We ca rried out an audit of 26 patients admitted to a neurological ICU with a diagnosis of status epilepticus, to identify deficiencies in diagnos is and management prior to transfer to the ICU, and examine the effect iveness of ICU management. On transfer, only 14 (54%) were in status e pilepticus; six were in drug-induced coma or were encephalopathic, and six had pseudostatus epilepticus, of whom four had been intubated. Th e commonest treatments prior to transfer were benzodiazepines, chlorme thiazole and phenytoin; the loading dose of phenytoin was inadequate i n at least 7/16 cases. All those in status epilepticus on transfer had their seizures successfully controlled, but ten required general anae sthesia with thiopentone, propofol, ketamine or midazolam. Two died-on e had a severe encephalitis and the other had had a cardiac arrest pri or to treatment. This study highlights deficiencies in the initial dia gnosis and management of status epilepticus, the role of specialist ne urological intensive care, and the importance of early referral.