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1 results

  • 7 - How Do I Manage Epilepsy Emergencies Like Status Epilepticus?

  • Patrick Landazuri, University of Kansas Medical Centre, Nuria Lacuey Lecumberri, University of Texas Health Science Center, Houston, Laura Vilella Bertran, University of Texas Health Science Center, Houston, Mark Farrenburg, University of Kansas Medical Centre, Samden Lhatoo, University of Texas Health Science Center, Houston
  • Book:
    Seizure and Epilepsy Care
    Published online:
    28 January 2023
    Print publication:
    09 February 2023, pp 129-138

  • Summary

    Status epilepticus (SE) is a neurological emergency defined as a continuous seizure or cluster of seizures lasting longer than 30 minutes. Because of increased mortality risk, SE is practically defined at 5 minutes. Clinically, SE can be separated into convulsive SE (CSE) or nonconvulsive SE (NCSE). For both diagnoses, the initial treatment of choice is a benzodiazepine, most commonly lorazepam 4 mg IV. Midazolam and diazepam (to a lesser extent) are also appropriate. If the status epilepticus continues, loading doses of fosphenytoin (20 mg/kg), levetiracetam (60 mg/kg), or valproate (40 mg/kg) are the next step in management. Continuation of SE past this point is considered refractory. For CSE, patients are almost always intubated and managed with IV anesthesia. For NCSE, intubation is often not needed at this point, with additional ASMs used instead to sidestep the risk associated with intubation and IV anesthesia. A key factor in guiding SE management is identifying the etiology (i.e., antibiotics for meningitis).Lastly, post cardiac arrest is briefly discussed as it is unfortunately commonly encountered.