Page created on June 3, 2021. Last updated on June 14, 2022 at 12:09
Status epilepticus is defined as either a single epileptic seizure lasting longer than 5 minutes, or more than one seizure without recovery of consciousness in-between. It’s more commonly a result of symptomatic seizure rather than epilepsy.
It’s a life-threatening condition with high mortality, as cerebral oedema, aspiration, shock, rhabdomyolysis, etc. may occur.
- 0th step: Ensure stability and free airways (ABC)
- 1st step: 1 dose BZD
- 10 mg midazolam i.m. or 10 – 20 mg diazepam i.v. or 4 mg lorazepam i.v.
- Alternative: buccal or rectal midazolam
- 2nd step: If no response within 1 minute -> give another dose of BZD
- 3nd step: If no resolution after 2 doses of BZD -> give antiepileptic
- Give IV loading dose followed by continuous infusion of an antiepileptic, like valproate, fosphenytoin, or levetiracetam
- 4nd step: If no resolution after antiepileptic -> give general anaesthesia
- With propofol or midazolam infusion
Midazolam has a short duration of action, and so lorazepam or diazepam, which last longer, is often preferred.
If the status remains after 2 doses of BZD the condition is called refractory or established status epilepticus.