Why won't it stop? The dynamics of benzodiazepine resistance in status epilepticus.
Nat Rev Neurol
; 18(7): 428-441, 2022 07.
Article
in En
| MEDLINE
| ID: mdl-35538233
ABSTRACT
Status epilepticus is a life-threatening neurological emergency that affects both adults and children. Approximately 36% of episodes of status epilepticus do not respond to the current preferred first-line treatment, benzodiazepines. The proportion of episodes that are refractory to benzodiazepines is higher in low-income and middle-income countries (LMICs) than in high-income countries (HICs). Evidence suggests that longer episodes of status epilepticus alter brain physiology, thereby contributing to the emergence of benzodiazepine resistance. Such changes include alterations in GABAA receptor function and in the transmembrane gradient for chloride, both of which erode the ability of benzodiazepines to enhance inhibitory synaptic signalling. Often, current management guidelines for status epilepticus do not account for these duration-related changes in pathophysiology, which might differentially impact individuals in LMICs, where the average time taken to reach medical attention is longer than in HICs. In this Perspective article, we aim to combine clinical insights and the latest evidence from basic science to inspire a new, context-specific approach to efficiently managing status epilepticus.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Status Epilepticus
/
Benzodiazepines
Type of study:
Guideline
Limits:
Adult
/
Child
/
Humans
Language:
En
Journal:
Nat Rev Neurol
Journal subject:
NEUROLOGIA
Year:
2022
Document type:
Article
Affiliation country: