The emergent evaluation and treatment of generalized convulsive status epilepticus presents challenges for emergency physicians. This disease is one of the few in which minutes can mean the difference between life and significant morbidity and mortality. It is imperative to use parallel processing and have multiple treatment options planned in advance, in case the current treatment is not successful. There is also benefit to exploring, or initiating, treatment algorithms to standardize the care for these critically ill patients.
Key points
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Status epilepticus (SE) is diagnosed at 5 minutes of continuous seizure activity, and has the potential for high morbidity and mortality if not diagnosed promptly and treated accurately and effectively.
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Devising specific protocols for management of SE improves outcomes.
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The first line for management of SE is benzodiazepines, followed by phenytoin, fosphenytoin, or valproic acid.
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Second line adjuncts for management of SE are levetiracetam, lacosamide, phenobarbital and ketamine, followed by intravenous anesthetics.
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Subtle SE occurs frequently after convulsive SE and should be treated in the same manner.
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Underlying causes leading to provoked seizures should be considered early on in the disease, especially in patients not responding to first line agents.
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