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THE MANAGEMENT OF REFRACTORY STATUS EPILEPTICUS IN ADULTS IN THE UK: NO CONSISTENCY IN PRACTICE SO TIME FOR A CHANGE?
  1. Mitesh Patel
  1. Undergraduate prize winner for audit University of Birmingham

    Abstract

    A 33 year old Caucasian female presented in intensive care unit (ICU) with prolonged seizure activity following a diagnosis of transient ischemic attack 48 hours earlier. Five anti–epileptic drugs and thirty–six hours later, the patient was finally stabilised. Would a standardised protocol and use of an EEG have helped in this situation?

    Status Epilepticus (SE) is a common neurological emergency with patients presenting with continued epileptic activity. Sub–optimal management contributes to a mortality rate of 19%.1 Continuous EEG monitoring and shared neurologist care is considered essential by NICE in the management of Refractory Status Epilepticus (RSE).2

    To determine current clinical practice in the management of RSE amongst adults in ICU, I carried out a UK national audit establishing if the use of a standardised protocol required re–inforcement within Trusts.

    I randomly selected 75 UK NHS Trusts and asked them to complete a questionnaire in addition to providing their protocol for RSE management in ICU. Fifty–five Trusts responded and while 31 (56% of responders) had a protocol available in ICU for early stages of SE, just 21 (38%) had specific guidelines if RSE occurred. Only 23 (42%) of Trusts involve neurologists at any stage of management and just 18 (33%) have access to continuous EEG monitoring.

    This study identified significant inconsistency in the management of SE in ICU's across the UK. Only a minority of ICU units have a protocol for RSE (38%) or access to continuous EEG monitoring (33%) despite it being considered fundamental for management and supported by NICE guidance.

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