Remarks on the Colombian consensus for the management of urgent epileptic seizures and status epilepticus

Abstract

We welcome the new Colombian consensus on “recommendations for the management of urgent epileptic crises and status epilepticus”. We believe that the concepts presented are clear and applicable to our daily clinical practice; however, we would like to make some observations on the use of intravenous (IV) anti-seizure therapy, which in our experience still poses significant challenges and leaves unmet needs for clinicians who deal with these cases on a daily basis.

As mentioned in the article, certain conditions require the use of IV anticonvulsant drugs. The choice of agent and duration of treatment depend on clinical evolution, patient tolerance, and the onset of complications. This makes it difficult to establish consensus in multidisciplinary teams, especially in intensive care, and has led to administrative conflicts, such as disputes over prolonged use.

In cases of crisis salvos or refractory status epilepticus (RSE), it is necessary to administer second-line IV drugs, such as levetiracetam, valproate, phenytoin, phenobarbital, lacosamide, or brivaracetam. The transition to oral administration depends on several factors: resolution of the status epilepticus (SE), tolerance to oral administration, absence of contraindications for enteral absorption, and preserved liver and kidney function. In patients with dysphagia or a high risk of recurrence, the use of a nasogastric tube may be considered to ensure continuity of treatment once the SE has been resolved.