17B. Status epilepticus

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.

2 thoughts on “17B. Status epilepticus”

  1. “Diazepam has a short duration of action, and so lorazepam, which lasts longer, is often preferred.”

    It says on AMBOSS that Diazepam is a long acting BZD, sure you did not mean Midazolam instead?

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