Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (à l’exclusion du nouveau‑né et du nourrisson)

Management of status epilepticus (SE) is subject to many difficulties: diagnosis, etiological investigation, non-specific and specific treatment. The French Society of Intensive Care and the French Society of Emergency Medicine, with the French Groupfor Pediatric Intensive Care and Emergencies, have developed guidelines to respond to the practical questions raised by SEmanagement in the prehospital setting, in the emergency department and the intensive care unit. Twenty-five experts haveanalyzed the literature and formulated recommendations according to the Grade of Recommendation Assessment, Development and Evaluation methodology. The experts agreed on 96 recommendations. Recommendations with the strongest levelof evidence concerned only generalized tonic convulsive SE. In this setting, first-line use of benzodiazepines (direct intravenousclonazepam or intramuscular midazolam) is recommended with a second injection in the case of clinical persistence of SE fiveminutes after the first injection. In the case of persistence of SE five minutes after this second injection, the recommendationis to administer second-line treatment: sodium valproate, (fos)phenytoin, phenobarbital or levetiracetam. The confirmed persistence of convulsions 30 minutes after the beginning of the administration of this second-line treatment defines refractorySE. At this stage, a coma should be rapidly induced by means of a third-line general anesthetic (midazolam and/or propofol).