management

Last edited 09/2018

Status epilepticus is a medical emergency and management of the condition varies considerably between adults, children and neonates.

The main aim in treating SE is to stop both clinical and electrographic seizure activity as soon as possible and to prevent their recurrence (1,2).

  • the early commencement of anticonvulsants will result in better long term outcome (3)
    • a rapid treatment sequence ideally according to a standardized protocol should be followed to avoid self-perpetuating seizures, emergence of recalcitrant seizures, and permanent neuronal injury (2)

Treatment of SE can be divided into

  • initial out-of-hospital treatment
  • treatment in the hospital
  • treatment of refractory status epilepticus (3)

NICE state that with respect to prolonged or repeated seizures and convulsive status epilepticus (4)

  • give immediate emergency care and treatment to children, young people and adults who have prolonged (lasting 5 minutes or more) or repeated (three or more in an hour) convulsive seizures in the community.
  • buccal midazolam or rectal diazepam should only be prescribed for use in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures
  • administer buccal midazolam as first-line treatment in children, young people and adults with prolonged (lasting 5 minutes or more) or repeated (three or more in an hour) seizures in the community
    • administer rectal diazepam if preferred or if buccal midazolam is not available
    • if intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam

Reference:

Related pages:

management of the child

management of the adult