Monotherapy or Polytherapy for First-Line Treatment of SE?

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State: Public
Version: Author's accepted manuscript
Serval ID
serval:BIB_DEF11D835BB1
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Monotherapy or Polytherapy for First-Line Treatment of SE?
Journal
Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society
Author(s)
Alvarez V., Rossetti A.O.
ISSN
1537-1603 (Electronic)
ISSN-L
0736-0258
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
33
Number
1
Pages
14-17
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Status epilepticus (SE) is one of the most frequent neurologic emergencies, and a rapid and effective treatment is warranted. Current guidelines recommend a stepwise approach using a sequence of different antiepileptic drugs with benzodiazepines (BZD) being the first treatment proposed. To provide the more effective treatment as soon as possible, some authors have suggested using a combined polytherapy as first-line treatment. Strong evidence supports the use of benzodiazepines, mostly lorazepam and midazolam as initial monotherapy treatment for SE. Insufficient data are available to support the use of nonsedating antiepileptic drugs as phenytoin, valproic acid, or levetiracetam without a previous benzodiazepine administration. Studies assessing the role of a combined initial therapy are rare, if not missing. Moreover, owing the wide range of SE etiologies, a "one fits all" initial polytherapy seems difficult to achieve. After reviewing the available evidence, guidelines, and current practices regarding monotherapy and polytherapy as first-line treatment in SE in adults, the authors propose a rational algorithm for early antiseizure treatment in SE.
Keywords
Algorithms, Anticonvulsants/administration & dosage, Benzodiazepines/administration & dosage, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination/methods, Evidence-Based Medicine, Humans, Polypharmacy, Status Epilepticus/diagnosis, Status Epilepticus/drug therapy, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
09/02/2016 15:27
Last modification date
20/08/2019 16:03
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