drug regimen for status epilepticus
Last reviewed 01/2018
The emergency treatment for convulsive status epilepticus in the adult consists of the following:
- premonitory stage (pre-hospital stage)
- diazepam 10−20 mg rectally, repeated once 15 minutes later if status continues to threaten, or
- midazolam 10 mg given buccally
- if seizures continue, treat as below.
- early status
- lorazepam (intravenous) 0.1 mg/kg (usually a 4 mg bolus, repeated once after 10−20 minutes; rate not critical)
- give usual AED medication if already on treatment
- for sustained control or if seizures continue, treat as below
- established status
- phenytoin infusion at a dose of 15–18 mg/kg at a rate of 50 mg/minute or
- fosphenytoin infusion at a dose of 15−20 mg phenytoin equivalents (PE)/kg at a rate of 50–100 mg PE/minute and/or
- phenobarbital bolus of 10–15 mg/kg at a rate of 100 mg/minute.
- reafractory status - the refractory stage (general anaesthesia) is reached 60/90 minutes after the initial therapy
- general anaesthesia, with one of:
- propofol (1–2 mg/kg bolus, then 2–10 mg/kg/hour) titrated to effect
- midazolam (0.1–0.2 mg/kg bolus, then 0.05–0.5 mg/kg/hour) titrated to effect
- thiopental sodium (3–5 mg/kg bolus, then 3–5 mg/kg/hour) titrated to effect; after 2–3 days infusion rate needs reduction as fat stores are saturated
- anaesthetic continued for 12−24 hours after the last clinical or electrographic seizure, then dose tapered
- in some instances, general anaesthesia should be initiated earlier and, occasionally, should be delayed (1)
Note:
- emergency treatment of SE should be administered in parallel with AED therapy. The choice of drugs depends on the following factors:
- previous therapy
- the type of epilepsy
- the clinical setting
- any pre-existing AED therapy should be continued at full dose, and any recent reductions reversed (1)
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