Management of Status epilepticus

Status epilepticus is the most severe and threatening form of an epileptic seizure and the second most common emergency in neurology. The therapeutic management is focused on three goals: maintenance of vital functions, identification of the cause or triggering factors, and immediate termination of the seizure activity. The factor of time is of crucial importance in this context. This also applies for the patients' survival probability and the development of persistent neuronal damage. Therefore special properties for such an "emergency"-anticonvulsant are requested. In case that the substance can be administered by the parenteral route, the options range from substances with a fast onset of action and sustained efficacy to those with a favourable safety profile (particularly in terms of cardiovascular conditions) and simple handling. The valproate injection solution fulfils many prerequisites and is a well known substance among experts. However, thus far it could only be used "off label" for this indication in most European countries. This obstacle was recently eliminated in Germany; the approval for the valproate injection solution (e. g. Orfiril® 100 mg/ml injection solution) was extended to include the treatment of patients with status epilepticus). This was reason enough for a clinical experience update at the 13th annual meeting of the German-Austrian-Swiss Working Group for Epilepsy held at the end of September 2007 in Morschach/Switzerland.

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