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Erschienen in: Zeitschrift für Epileptologie 4/2018

06.08.2018 | Status epilepticus | Leitthema

Initiale Therapie des Status epilepticus

Welche Therapie erfolgt zu Hause und im Rettungswagen?

verfasst von: Gabriel Möddel, PD Dr. Christoph Kellinghaus, Adam Strzelczyk

Erschienen in: Clinical Epileptology | Ausgabe 4/2018

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Zusammenfassung

Der Status epilepticus gehört zu den wichtigsten neurologischen Notfallsituationen, die eine sofortige medizinische Behandlung erfordern. Eine schnelle und ausreichend dosierte Behandlung ist wichtig, um das Therapieoutcome zu optimieren und die Mortalität zu reduzieren. Hier geben wir einen Überblick über mögliche Behandlungsstrategien des Status epilepticus im häuslichen Umfeld und im Rettungswagen.
Literatur
1.
Zurück zum Zitat Abou-Khalil B, Wheless J, Rogin J, Wolter KD, Pixton GC, Shukla RB, Sherman NA, Sommerville K, Goli V, Roland CL (2013) A double-blind, randomized, placebo-controlled trial of a diazepam auto-injector administered by caregivers to patients with epilepsy who require intermittent intervention for acute repetitive seizures. Epilepsia 54:1968–1976CrossRef Abou-Khalil B, Wheless J, Rogin J, Wolter KD, Pixton GC, Shukla RB, Sherman NA, Sommerville K, Goli V, Roland CL (2013) A double-blind, randomized, placebo-controlled trial of a diazepam auto-injector administered by caregivers to patients with epilepsy who require intermittent intervention for acute repetitive seizures. Epilepsia 54:1968–1976CrossRef
2.
Zurück zum Zitat Agarwal SK, Kriel RL, Brundage RC, Ivaturi VD, Cloyd JC (2013) A pilot study assessing the bioavailability and pharmacokinetics of diazepam after intranasal and intravenous administration in healthy volunteers. Epilepsy Res 105:362–367CrossRef Agarwal SK, Kriel RL, Brundage RC, Ivaturi VD, Cloyd JC (2013) A pilot study assessing the bioavailability and pharmacokinetics of diazepam after intranasal and intravenous administration in healthy volunteers. Epilepsy Res 105:362–367CrossRef
3.
Zurück zum Zitat Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, Gottwald MD, O’Neil N, Neuhaus JM, Segal MR, Lowenstein DH (2001) A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 345:631–637CrossRef Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, Gottwald MD, O’Neil N, Neuhaus JM, Segal MR, Lowenstein DH (2001) A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 345:631–637CrossRef
5.
Zurück zum Zitat Arya R, Gulati S, Kabra M, Sahu JK, Kalra V (2011) Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. Epilepsia 52:788–793CrossRef Arya R, Gulati S, Kabra M, Sahu JK, Kalra V (2011) Intranasal versus intravenous lorazepam for control of acute seizures in children: a randomized open-label study. Epilepsia 52:788–793CrossRef
6.
Zurück zum Zitat Ashrafi MR, Khosroshahi N, Karimi P, Malamiri RA, Bavarian B, Zarch AV, Mirzaei M, Kompani F (2010) Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol 14:434–438CrossRef Ashrafi MR, Khosroshahi N, Karimi P, Malamiri RA, Bavarian B, Zarch AV, Mirzaei M, Kompani F (2010) Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol 14:434–438CrossRef
7.
Zurück zum Zitat Betjemann JP, Lowenstein DH (2015) Status epilepticus in adults. Lancet Neurol 14:615–624CrossRef Betjemann JP, Lowenstein DH (2015) Status epilepticus in adults. Lancet Neurol 14:615–624CrossRef
10.
Zurück zum Zitat Crawford TO, Mitchell WG, Snodgrass SR (1987) Lorazepam in childhood status epilepticus and serial seizures: effectiveness and tachyphylaxis. Neurology 37:190–195CrossRef Crawford TO, Mitchell WG, Snodgrass SR (1987) Lorazepam in childhood status epilepticus and serial seizures: effectiveness and tachyphylaxis. Neurology 37:190–195CrossRef
11.
Zurück zum Zitat Crevoisier C, Delisle MC; Joseph I, Foletti G (2003) Comparative Single-Dose Pharmacokinetics of Clonazepam following Intravenous, Intramuscular and Oral Administration to Healthy Volunteers. Eur Neurology 49:173–177 Crevoisier C, Delisle MC; Joseph I, Foletti G (2003) Comparative Single-Dose Pharmacokinetics of Clonazepam following Intravenous, Intramuscular and Oral Administration to Healthy Volunteers. Eur Neurology 49:173–177
14.
Zurück zum Zitat Fisgin T, Gurer Y, Tezic T, Senbil N, Zorlu P, Okuyaz C, Akgun D (2002) Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. J Child Neurol 17:123–126CrossRef Fisgin T, Gurer Y, Tezic T, Senbil N, Zorlu P, Okuyaz C, Akgun D (2002) Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. J Child Neurol 17:123–126CrossRef
17.
Zurück zum Zitat De Haan GJ, Van Der Geest P, Doelman G, Bertram E, Edelbroek P (2010) A comparison of midazolam nasal spray and diazepam rectal solution for the residential treatment of seizure exacerbations. Epilepsia 51:478–482CrossRef De Haan GJ, Van Der Geest P, Doelman G, Bertram E, Edelbroek P (2010) A comparison of midazolam nasal spray and diazepam rectal solution for the residential treatment of seizure exacerbations. Epilepsia 51:478–482CrossRef
18.
Zurück zum Zitat Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, Healy A, Firth S, Filloux F (2010) Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med 164:747–753CrossRef Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, Healy A, Firth S, Filloux F (2010) Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med 164:747–753CrossRef
19.
Zurück zum Zitat Kapur J, MacDonald RL (1997) Rapid seizure-induced reduction of benzodiazepine and Zn2+ sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci 17:7532–7540CrossRef Kapur J, MacDonald RL (1997) Rapid seizure-induced reduction of benzodiazepine and Zn2+ sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci 17:7532–7540CrossRef
20.
Zurück zum Zitat Kay L, Reif PS, Belke M, Bauer S, Frund D, Knake S, Rosenow F, Strzelczyk A (2015) Intranasal midazolam during presurgical epilepsy monitoring is well tolerated, delays seizure recurrence, and protects from generalized tonic-clonic seizures. Epilepsia 56:1408–1414CrossRef Kay L, Reif PS, Belke M, Bauer S, Frund D, Knake S, Rosenow F, Strzelczyk A (2015) Intranasal midazolam during presurgical epilepsy monitoring is well tolerated, delays seizure recurrence, and protects from generalized tonic-clonic seizures. Epilepsia 56:1408–1414CrossRef
21.
Zurück zum Zitat Kortland LM, Alfter A, Bahr O, Carl B, Dodel R, Freiman TM, Hubert K, Jahnke K, Knake S, von Podewils F, Reese JP, Runge U, Senft C, Steinmetz H, Rosenow F, Strzelczyk A (2016) Costs and cost-driving factors for acute treatment of adults with status epilepticus: A multicenter cohort study from Germany. Epilepsia 57:2056–2066CrossRef Kortland LM, Alfter A, Bahr O, Carl B, Dodel R, Freiman TM, Hubert K, Jahnke K, Knake S, von Podewils F, Reese JP, Runge U, Senft C, Steinmetz H, Rosenow F, Strzelczyk A (2016) Costs and cost-driving factors for acute treatment of adults with status epilepticus: A multicenter cohort study from Germany. Epilepsia 57:2056–2066CrossRef
22.
Zurück zum Zitat Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M (2000) Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ 321:83–86CrossRef Lahat E, Goldman M, Barr J, Bistritzer T, Berkovitch M (2000) Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. BMJ 321:83–86CrossRef
23.
Zurück zum Zitat Lowenstein DH, Alldredge BK (1993) Status epilepticus at an urban public hospital in the 1980s. Neurology 43:483–488CrossRef Lowenstein DH, Alldredge BK (1993) Status epilepticus at an urban public hospital in the 1980s. Neurology 43:483–488CrossRef
24.
Zurück zum Zitat Lowenstein DH, Bleck T, MacDonald RL (1999) It’s time to revise the definition of status epilepticus. Epilepsia 40:120–122CrossRef Lowenstein DH, Bleck T, MacDonald RL (1999) It’s time to revise the definition of status epilepticus. Epilepsia 40:120–122CrossRef
25.
Zurück zum Zitat Mahmoudian T, Zadeh MM (2004) Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav 5:253–255CrossRef Mahmoudian T, Zadeh MM (2004) Comparison of intranasal midazolam with intravenous diazepam for treating acute seizures in children. Epilepsy Behav 5:253–255CrossRef
26.
Zurück zum Zitat Mccormick EM, Lieh-LAI M, Knazik S, Nigro M (1999) A prospective comparison of midazolam and lorazepam in the initial treatment of status epilepticus in the pediatric patient. Epilepsia 40(Suppl 7):160 Mccormick EM, Lieh-LAI M, Knazik S, Nigro M (1999) A prospective comparison of midazolam and lorazepam in the initial treatment of status epilepticus in the pediatric patient. Epilepsia 40(Suppl 7):160
27.
Zurück zum Zitat Mcintyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, Martland T, Berry K, Collier J, Smith S, Choonara I (2005) Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 366:205–210CrossRef Mcintyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, Martland T, Berry K, Collier J, Smith S, Choonara I (2005) Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial. Lancet 366:205–210CrossRef
28.
Zurück zum Zitat Mcmullan J, Sasson C, Pancioli A, Silbergleit R (2010) Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med 17:575–582CrossRef Mcmullan J, Sasson C, Pancioli A, Silbergleit R (2010) Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med 17:575–582CrossRef
29.
Zurück zum Zitat Meldrum BS, Brierley JB (1973) Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. Arch Neurol 28:10–17CrossRef Meldrum BS, Brierley JB (1973) Prolonged epileptic seizures in primates. Ischemic cell change and its relation to ictal physiological events. Arch Neurol 28:10–17CrossRef
30.
Zurück zum Zitat Meldrum BS, Horton RW (1973) Physiology of status epilepticus in primates. Arch Neurol 28:1–9CrossRef Meldrum BS, Horton RW (1973) Physiology of status epilepticus in primates. Arch Neurol 28:1–9CrossRef
31.
Zurück zum Zitat Chamberlain JM, Okada P, Holsti M, Mahajan P, Brown KM, Vance C, Gonzalez V, Lichenstein R, Stanley R, Brousseau DC, Grubenhoff J, Zemek R, Johnson DW, Clemons TE, Baren J, Pediatric Emergency Care Applied Research Network (PECARN) (2014) Lorazepam vs diazepam for pediatric status epilepticus: a randomized clinical trial. JAMA 311:1652–1660CrossRef Chamberlain JM, Okada P, Holsti M, Mahajan P, Brown KM, Vance C, Gonzalez V, Lichenstein R, Stanley R, Brousseau DC, Grubenhoff J, Zemek R, Johnson DW, Clemons TE, Baren J, Pediatric Emergency Care Applied Research Network (PECARN) (2014) Lorazepam vs diazepam for pediatric status epilepticus: a randomized clinical trial. JAMA 311:1652–1660CrossRef
33.
Zurück zum Zitat Rice AC, Delorenzo RJ (1999) N‑methyl-D-aspartate receptor activation regulates refractoriness of status epilepticus to diazepam. Neuroscience 93:117–123CrossRef Rice AC, Delorenzo RJ (1999) N‑methyl-D-aspartate receptor activation regulates refractoriness of status epilepticus to diazepam. Neuroscience 93:117–123CrossRef
34.
Zurück zum Zitat Rosenow F (2012) Status epilepticus im Erwachsenenalter. In: Diener HC, Weimar C (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart Rosenow F (2012) Status epilepticus im Erwachsenenalter. In: Diener HC, Weimar C (Hrsg) Leitlinien für Diagnostik und Therapie in der Neurologie. Thieme, Stuttgart
35.
Zurück zum Zitat Sanchez Fernandez I, Gainza-Lein M, Loddenkemper T (2017) Nonintravenous rescue medications for pediatric status epilepticus: A cost-effectiveness analysis. Epilepsia 58:1349–1359CrossRef Sanchez Fernandez I, Gainza-Lein M, Loddenkemper T (2017) Nonintravenous rescue medications for pediatric status epilepticus: A cost-effectiveness analysis. Epilepsia 58:1349–1359CrossRef
36.
Zurück zum Zitat Scott RC, Besag FM, Neville BG (1999) Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 353:623–626CrossRef Scott RC, Besag FM, Neville BG (1999) Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: a randomised trial. Lancet 353:623–626CrossRef
37.
Zurück zum Zitat Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, Barsan W, for the NETT investigators (2012) Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus. N Engl J Med 366:591–600CrossRef Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, Barsan W, for the NETT investigators (2012) Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus. N Engl J Med 366:591–600CrossRef
38.
Zurück zum Zitat Singhi S, Murthy A, Singhi P, Jayashree M (2002) Continuous midazolam versus diazepam infusion for refractory convulsive status epilepticus. J Child Neurol 17:106–110CrossRef Singhi S, Murthy A, Singhi P, Jayashree M (2002) Continuous midazolam versus diazepam infusion for refractory convulsive status epilepticus. J Child Neurol 17:106–110CrossRef
39.
Zurück zum Zitat Knake S, Rosenow F, Vescovi M, Oertel WH, Mueller HH, Wirbatz A, Katsarou N, Hamer HM, Status Epilepticus Study Group (2001) Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia 42:714–718CrossRef Knake S, Rosenow F, Vescovi M, Oertel WH, Mueller HH, Wirbatz A, Katsarou N, Hamer HM, Status Epilepticus Study Group (2001) Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia 42:714–718CrossRef
40.
Zurück zum Zitat Strzelczyk A, Knake S, Oertel WH, Rosenow F, Hamer HM (2013) Inpatient treatment costs of status epilepticus in adults in Germany. Seizure 22:882–885CrossRef Strzelczyk A, Knake S, Oertel WH, Rosenow F, Hamer HM (2013) Inpatient treatment costs of status epilepticus in adults in Germany. Seizure 22:882–885CrossRef
42.
Zurück zum Zitat Thakker A, Shanbag P (2013) A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures. J Neurol 260:470–474CrossRef Thakker A, Shanbag P (2013) A randomized controlled trial of intranasal-midazolam versus intravenous-diazepam for acute childhood seizures. J Neurol 260:470–474CrossRef
43.
Zurück zum Zitat Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, Shorvon S, Lowenstein DH (2015) A definition and classification of status epilepticus – report of the Ilae task force on classification of status epilepticus. Epilepsia 56:1515–1523CrossRef Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, Shorvon S, Lowenstein DH (2015) A definition and classification of status epilepticus – report of the Ilae task force on classification of status epilepticus. Epilepsia 56:1515–1523CrossRef
44.
Zurück zum Zitat Welch RD, Nicholas K, Durkalski-Mauldin VL, Lowenstein DH, Conwit R, Mahajan PV, Lewandowski C, Silbergleit R (2015) Neurological Emergencies Treatment Trials (Nett) Network Investigators. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia 56:254–262CrossRef Welch RD, Nicholas K, Durkalski-Mauldin VL, Lowenstein DH, Conwit R, Mahajan PV, Lewandowski C, Silbergleit R (2015) Neurological Emergencies Treatment Trials (Nett) Network Investigators. Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia 56:254–262CrossRef
45.
Zurück zum Zitat Wu W, Zhang L, Xue R (2016) Lorazepam or diazepam for convulsive status epilepticus: A meta-analysis. J Clin Neurosci 29:133–138CrossRef Wu W, Zhang L, Xue R (2016) Lorazepam or diazepam for convulsive status epilepticus: A meta-analysis. J Clin Neurosci 29:133–138CrossRef
46.
Zurück zum Zitat Zhao ZY, Wang HY, Wen B, Yang ZB, Feng K, Fan JC (2016) A comparison of Midazolam, Lorazepam, and diazepam for the treatment of status Epilepticus in children: a network Meta-analysis. J Child Neurol 31:1093–1107CrossRef Zhao ZY, Wang HY, Wen B, Yang ZB, Feng K, Fan JC (2016) A comparison of Midazolam, Lorazepam, and diazepam for the treatment of status Epilepticus in children: a network Meta-analysis. J Child Neurol 31:1093–1107CrossRef
Metadaten
Titel
Initiale Therapie des Status epilepticus
Welche Therapie erfolgt zu Hause und im Rettungswagen?
verfasst von
Gabriel Möddel
PD Dr. Christoph Kellinghaus
Adam Strzelczyk
Publikationsdatum
06.08.2018
Verlag
Springer Medizin
Erschienen in
Clinical Epileptology / Ausgabe 4/2018
Print ISSN: 2948-104X
Elektronische ISSN: 2948-1058
DOI
https://doi.org/10.1007/s10309-018-0204-z

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