Key Concepts

O Status epilepticus (SE) is a neurologic emergency that can lead to permanent brain damage or death.

© SE can be defined as any seizure lasting more than 30 minutes, with or without loss of consciousness, or having recurrent seizures without regaining consciousness between episodes. However, this definition does not provide any guidance for treatment in the clinical setting where interventions begin within a few minutes of seizure onset. A more practical definition would be continuous seizure activity lasting more than 5 minutes, or two or more seizures without complete recovery of consciousness.

It is important to evaluate possible etiologies of SE and treat underlying causes to optimize seizure control.

The goal of therapy is to arrest physical and electroencephalographic evidence of seizures, prevent their recurrence, and minimize adverse drug events.

The first-line treatment for SE is IV benzodiazepines. Lorazepam, diazepam, or midazolam may be used to rapidly control clinical signs of seizures. Lorazepam is currently considered the first-line agent by most clinicians.

® Antiepileptic drugs (AEDs) are used to prevent the seizure recurrence. IV phenytoin (or fosphenytoin) and phenobarbital are administered after benzo-diazepines.

© Refractory status epilepticus (RSE) is seizure activity that is not controlled by first- and second-line therapies, including benzodiazepines and AEDs.

® Midazolam, propofol, and pentobarbital infusions can be used for RSE, but intensive monitoring and supportive care are required.

Status epilepticus (SE) is a neurologic emergency that can lead to permanent brain damage or death. SE can be defined as any seizure lasting more than 30 minutes, with or without a loss of consciousness; or having recurrent seizures without regaining consciousness between episodes.1 However, this definition does not provide any guidance for treatment in the clinical setting where interventions begin within a few minutes of seizure onset. A more practical definition would be continuous seizures lasting more than 5 minutes or two or more seizures without complete recovery of consciousness2 Refractory status epilepticus (RSE) can be defined as seizure activity that does not respond to first-or second-line antiepileptic therapy.

SE can present as nonconvulsive status epilepticus (NCSE) or generalized convulsive status epilepticus (GCSE). NCSE is characterized by a persistent state of impaired consciousness and/or motor or sensory seizures without impaired consciousness. For patients with NCSE, electroencephalography (EEG) is essential for diagnosis. GCSE is characterized by full body motor seizures and involves the entire brain. This chapter will focus on GCSE, the most common type of SE, which is associated with the greatest risk of neurologic and physical damage.

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