Resumen
Introducción: las crisis epilépticas aisladas de alto riesgo, el clúster de crisis y el estado epiléptico, se engloban bajo el concepto de crisis epilépticas urgentes. Esta situación clínica es muy prevalente y tiene un impacto negativo en la morbimortalidad de los pacientes. El tratamiento rápido y adecuado es uno de los factores pronósticos más importantes para mejorar el desenlace funcional de estos pacientes.
Materiales y métodos: se formó un grupo de trabajo con 11 expertos en epilepsia y medicina de emergencias, guiado por un experto internacional. Se elaboraron recomendaciones sobre el manejo de las crisis epilépticas urgentes, basadas en la información obtenida por una revisión sistemática de la literatura (periodo 2014-2024). Los hallazgos se evaluaron mediante la metodología Delphi, estableciendo un umbral de aceptación con una mediana de 9 (rango intercuartil <1,5) y permitiendo a los miembros votar y discutir las recomendaciones. Una reunión académica facilitó un análisis detallado y la elaboración del consenso final.
Resultados: los resultados se agruparon en seis subtipos de recomendaciones que abarcaron: definición de conceptos, tratamiento inicial de las crisis epilépticas urgentes, tratamiento de las crisis epilépticas aisladas de alto riesgo, tratamiento de clúster de crisis, tratamiento del estado epiléptico motor y otras recomendaciones.
Conclusiones: en pacientes con crisis epilépticas urgentes, la variable que más influyó en el pronóstico funcional fue la velocidad en la instauración del tratamiento, por lo anterior, el consenso de expertos recomendó ofrecer un tratamiento rápido y organizado. Este tratamiento se debe individualizar a partir del escenario clínico y las comorbilidades específicas de cada paciente.
Citas
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