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ALL / Neurology

Status epilepticus

Status epilepticus

Status epilepticus is defined as:
  • a single seizure lasting >5 minutes, or
  • >= 2 seizures within a 5-minute period without the person returning to normal between them

This is a medical emergency. The priority is the termination of seizure activity, which if prolonged will lead to irreversible brain damage.

Management
  • ABC
    • airway adjunct
    • oxygen
    • check blood glucose
  • First-line drugs are benzodiazepines
    • in the prehospital setting PR diazepam or buccal midazolam may be given
    • in hospital IV lorazepam is generally used. This may be repeated once after 5-10minutes
  • If ongoing (or 'established') status it is appropriate to start a second-line agent such as levetiracetam, phenytoin or sodium valproate
    • NICE state 'Take into account that levetiracetam may be quicker to administer and have fewer adverse effects than the alternative options.'
  • If no response ('refractory status', typically defined as failure of benzodiazepine + one appropriate second-line agent) within 30-60 minutes from onset:
    • ITU admission
    • induction of general anaesthesia (e.g. propofol, thiopentone, midazolam infusion)
    • continuous EEG monitoring if available

+PassMedicine Notes
Status epilepticus is defined as:
  • a single seizure lasting >5 minutes, or
  • >= 2 seizures within a 5-minute period without the person returning to normal between them

This is a medical emergency. The priority is the termination of seizure activity, which if prolonged will lead to irreversible brain damage.

Management
  • ABC
    • airway adjunct
    • oxygen
    • check blood glucose
  • First-line drugs are benzodiazepines
    • in the prehospital setting PR diazepam or buccal midazolam may be given
    • in hospital IV lorazepam is generally used. This may be repeated once after 5-10minutes
  • If ongoing (or 'established') status it is appropriate to start a second-line agent such as levetiracetam, phenytoin or sodium valproate
    • NICE state 'Take into account that levetiracetam may be quicker to administer and have fewer adverse effects than the alternative options.'
  • If no response ('refractory status', typically defined as failure of benzodiazepine + one appropriate second-line agent) within 30-60 minutes from onset:
    • ITU admission
    • induction of general anaesthesia (e.g. propofol, thiopentone, midazolam infusion)
    • continuous EEG monitoring if available

Acute management of status epilepticus



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