Status epilepticus

Status epilepticus is a prolonged seizure, usually defined as >30 minutes.

Over half of patients presenting with status epilepticus do not have known epilepsy.

The main acute causes in adults are:
  • stroke
  • hypoxia
  • metabolic derangement
  • alcohol intoxication or withdraw
In children, the leading cause is infection.

  • secure airway and resuscitate
  • give oxygen
  • anti-epileptics:
    • pre-hospital: diazepam 10-20mg PR or midazolam 10mg buccally
    • first line in hospital: lorazepam (or diazepam) IV
      • terminates around 75-80% of seizures
    • if benzo unsuccessful: phenytoin infusion 15-18mg/kg at a rate of 50mg/minute 
      • will terminate around 50% of resistant seizures
  • if any suggestion of alcohol abuse or impaired nutrition give 50mls of 50% glucose and/or 250mg IV thiamine
  • if status is refractory (ie not resolved 60-90 minutes after initial anti-epileptic) anaesthetise using propofol, midazolam or thiopental sodium.

Prognosis: mortality of 10-20% rising to nearly 50% in refractory status epilepticus. 

author profile image

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book.

Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)