5. Treatment of status epilepticus

Page created on February 8, 2022. Not updated since.

Definition

Status epilepticus is defined as either:

• Ongoing seizure activity (> 30 minutes)
• Repetitive seizures for greater than 30 minutes without recovery of consciousness in between

However, because of poor prognosis, treatment is initiated if the seizure persists for more than 5 minutes (we don’t wait for 30 minutes).

Etiology

• Drug intoxication
• Drug withdrawal
• Hypoglycaemia
• Electrolyte imbalance
• Head trauma
• Infection
• Ischaemic stroke
• Intracranial haemorrhage
• Metabolic disorders
• Hypoxia
• Epilepsy

Treatment of status epilepticus

• 0^th step: ABC
• 1^st step: Benzodiazepine
  • If vascular access: IV 0,2 – 0,5 mg/kg diazepam (or midazolam or lorazepam)
  • If not: i.m. midazolam or buccal midazolam or rectal diazepam
• 2^nd step: Repeat benzo doze
• 3^rd step: Antiepileptic
  • Phenytoin or fosphenytoin or levetiracetam or valproate or phenobarbital
• 4^th step: General anaesthesia