Epilepsy Evidence
Sources behind the EEG, status epilepticus, and maintenance tools.
Emergency EEG Triage
NCSE detection, EEG urgency classification, and critical care EEG standards
18% of comatose patients in medical/neuro ICU had NCSE detectable only by EEG -- not clinically apparent.
ACNS 2021 critical care EEG terminology: defines ictal-interictal continuum patterns (LPDs, GPDs, LRDA) requiring urgent interpretation.
NCSE accounts for 25-30% of all SE; mortality directly correlates with delay to EEG diagnosis and treatment.
Post-cardiac arrest: malignant EEG patterns (burst suppression, status epilepticus) are independent predictors of poor neurological outcome.
Status Epilepticus Protocol
Phase-locked treatment, benzodiazepine trials, and second-line ASM evidence
IM midazolam 10 mg vs IV lorazepam 4 mg for prehospital SE. Primary endpoint (seizure cessation without rescue Rx): 73.4% vs 63.4% (p<0.001). IM midazolam superior on primary outcome.
Levetiracetam vs fosphenytoin vs valproate for established SE. Seizure termination at 60 min: 47.4% vs 53.6% vs 45.7% (no significant difference). All three are acceptable second-line agents.
Neurocritical Care Society guidelines for evaluation and management of status epilepticus.
Level A: BZDs (lorazepam IV, IM midazolam, diazepam IV) are the preferred initial therapy for established SE. All equivalent when used at equivalent doses.
Outpatient Maintenance
ASM selection evidence, spectrum coverage, and pharmacologic review sources
Primary modeling source for focal first-line comparisons, pharmacokinetics, generalized-epilepsy guardrails, substitution versus add-on logic, and rational combination cautions.
Primary modeling source for pregnancy, folic acid, contraception, teratogenicity, and pregnancy-related serum-level shifts across common ASMs.
Supports prioritizing lamotrigine, levetiracetam, or oxcarbazepine in people of childbearing potential and avoiding valproate when possible.
Scope