key: cord-0920864-bmqp14s3
authors: Kinney, Michael O.; Brigo, Francesco; Kaplan, Peter W.
title: Optimizing status Epilepticus care during the COVID-19 pandemic
date: 2020-04-21
journal: Epilepsy Behav
DOI: 10.1016/j.yebeh.2020.107124
sha: 3201b2d5a89da48d7d6b97c4469f831dfc73f62f
doc_id: 920864
cord_uid: bmqp14s3

nan

The COVID-19 pandemic has created a huge surge in demand for intensive care resources in a short time-frame, overwhelming some national and sub-regional health systems, and resulting in the need for resource rationing. COVID-19 will likely have major implications on the management of status epilepticus (SE) in the intensive care unit (ICU) due to potential limits in ventilator and staff capacity.

SE is one of the commonest serious neurological emergencies in the ICU, with arguably one of the most modifiable early trajectories, potentially reducing the need for ICU admission.

Incident rates of patients with SE are as high as 74/100,000 population per year (1), with one population study suggesting 6/100,000 being refractory to first and second line therapy (refractory convulsive status epilepticus) thereby requiring ICU (2) . The other major form of SE treated in ICU is non-convulsive status epilepticus (NCSE) in coma, either from de-novo acute brain injuries or "subtle" SE after convulsive SE. The case fatality from population based studies, composed of different etiologies ranges from 5% to 39% (1).

In these difficult times, we urge the neurological community to take ownership, by reconsidering SE care and how best to assist our ICU colleagues by consideration of the following four key points.

(1) Reducing the volume of referrals or shorten the time spent in ICU.

Proactive neurological decision making on the appropriateness of referrals to ICU and actively considering interventions to minimise time in ICU will reduce ICU bed days during the surge phase. Some strategies are suggested:

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