The importance of treatment protocols for the management of status epilepticus
- Correspondence to Dr Aidan Neligan, NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical & Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK;
Generalised convulsive status epilepticus, once eloquently described as the maximum expression of epilepsy, has long been recognised as being fatal if not promptly treated. Treatment algorithms for managing status epilepticus only became possible with the emergence of benzodiazepines in the 1960s and 1970s; and with the development of parenteral formulations of antiepileptic drugs and anaesthetic agents for example, intravenous propofol (1977) and intravenous midazolam (1978). Of particular importance was the availability of phenytoin (originally developed by Merritt and Putman in 1938) in intravenous formulation, with its first reported intravenous use in three individuals in 1956, although intravenous phenobarbital had been available since the 1920s. The availability of different therapeutic options led to treatment protocols from the mid-1970s, whereas before this, clinicians would advocate preferred single agents—for example, many considered intramuscular paraldehyde as the treatment of choice until then.1 ,2 All published protocols since the 1970s, including contemporary protocols, promote a staged approach to treatment.