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.