Drug treatment of complex partial status epilepticus

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How aggressively complex partial status epilepticus needs to be treated is a matter of some controversy. It is the author's view that in most cases there is little risk of cerebral damage due to the seizures, and for this reason intravenous therapy is not needed unless the condition is particularly severe or resistant. Others disagree and treat complex partial status using similar protocols to that described above for tonic-clonic status. There is, however, no good evidence that aggressive treatment improves the prognosis in this condition, and intravenous medication can result in hypotension, respiratory depression, and occasionally cardio-respiratory arrest. In one series of non-convulsive status epilepticus in the elderly, aggressive treatment carried a worse prognosis than no treatment.

At present, treatment with oral benzodiazepines is usually first-line therapy. Lorazepam or clobazam are the most commonly prescribed drugs. In patients who have repetitive attacks of complex partial status epilepticus (a common occurrence), oral clobazam over a period of 2-3 days given early at home can abort the status epilepticus, and such strategies should be discussed with the patient and carers. The response to benzodiazepines can be disappointing. Often there is only a slow and partial improvement, in marked contrast to the complete and rapid improvement in absence status epilepticus. In other patients there may be resolution of the electrographic status epilepticus without concomitant clinical improvement. Although the response to benzodiazepines is often not complete, most episodes are self-limiting, and will recover spontaneously.

Treatment of the underlying cause where this is possible (e.g. encephalitis or metabolic derangement) is of course paramount. The routine maintenance antiepileptic drug regimen should also manipulated to provide maximum control of seizures.

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