Guidelines for Status Epilepticus: Are We There Yet?

Excerpt

Guidelines are a curate’s egg. They are to be welcomed for the obvious reason that clinicians need advice, and especially so in emergency settings, and the simple fact that in status epilepticus, for instance, the adoption of a protocol improves outcome. Also, it is important to take a scientific approach to the evaluation of evidence, and guidelines offer this potential. Herein, however, lie their drawbacks. Hard evidence is scarce on the ground in many clinical situations and where strictly evidence-based recommendations only are made in a guideline, the guidelines tend to be bland and self-evident. Conversely, where the guideline strays from the evidence-based path, there is an inevitable adoption of subjective and selective opinion. The therapy of status epilepticus presents a classic example of this problem. …