Acute Systemic Complications of Convulsive Status Epilepticus—A Systematic Review

Objectives: Status epilepticus is a neurologic emergency with high morbidity and mortality requiring neurointensive care and treatment of systemic complications. This systematic review compiles the current literature on acute systemic complications of generalized convulsive status epilepticus in adults and their immediate clinical impact along with recommendations for optimal neurointensive care. Data Sources: We searched PubMed, Medline, Embase, and the Cochrane library for articles published between 1960 and 2016 and reporting on systemic complications of convulsive status epilepticus. Study Selection: All identified studies were screened for eligibility by two independent reviewers. Data Extraction: Key data were extracted using standardized data collection forms. Data Synthesis: Thirty-two of 3,046 screened articles were included. Acute manifestations and complications reported in association with generalized convulsive status epilepticus can affect all organ systems fueling complex cascades and multiple organ interactions. Most reported complications result from generalized excessive muscle contractions that increase body temperature and serum potassium levels and may interfere with proper and coordinated function of respiratory muscles followed by hypoxia and respiratory acidosis. Increased plasma catecholamines can cause a decay of skeletal muscle cells and cardiac function, including stress cardiomyopathy. Systemic complications are often underestimated or misinterpreted as they may mimic underlying causes of generalized convulsive status epilepticus or treatment-related adverse events. Conclusions: Management of generalized convulsive status epilepticus should center on the administration of antiseizure drugs, treatment of the underlying causes, and the attendant systemic consequences to prevent secondary seizure-related injuries. Heightened awareness, systematic clinical assessment, and diagnostic workup and management based on the proposed algorithm are advocated as they are keys to optimal outcome. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://ift.tt/29S62lw). This work was performed at Universtiy Hospital Basel, Basel, Switzerland. Dr. Sutter received research grants from the Swiss National Foundation (No 320030_169379), the Research Fund of the University Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter-Rhyner Foundation. He received personal grants from the Union Chimique Belge (UCB)-pharma and holds stocks from Novartis and Roche. Dr. Rüegg’s institution received funding from UCB, Novartis, and Swiss National Science Foundation Grants: grant number 320030_169379/1 and coapplicant for grants numbers 33CM30_125115/1 and 33CM30_140338/1; he disclosed that he is the President of the Swiss League against Epilepsy (no payments), Editor of EPILEPTOLOGIE (Journal of the Swiss League against Epilepsy) (no payments), and Editor of the Swiss EEG Bulletin (payments from UCB); he received honoraria from serving on the scientific advisory boards of Desitin, Eisai, GlaxoSmithKline (GSK), and UCB-pharma, travel grants from GSK, Janssen-Cilag, UCB-pharma, speaker fees from UCB-pharma and from serving as a consultant for Eisai, GSK, Janssen-Cilag, Pfizer, Novartis, and UCB-pharma; and he does not hold any stocks of any pharmaceutical industries or manufacturers of medical devices. Dr. Kaplan received funding from the Amercian Clinical Neurophysiology Society (board) and from serving as an expert witness; he has provided unsponsored grand rounds; and he published books on electroencephalogram (EEG), status epilepticus and epilepsy, and is on Qatar Research Foundation grant on continuous EEG monitoring in status epilepticus. The remaining authors have disclosed that they do not have any potential conflicts of interest. Dr. Sutter, Dittrich, and Dr. Semmlack have designed this review, did the literature search, analyzed the data, written the article, and designed the tables and figures. Drs. Rüegg, Marsch, and Kaplan have analyzed the data, written parts of the article, and revised the article. For information regarding this article, E-mail: Raoul.Sutter@usb.ch Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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