management of the adult

Last reviewed 01/2018

Seek expert guidance and consult local guidelines.

The protocol for treating convulsive status epilepticus in adults is as follows:

• 1st stage (0-10 minutes) - early status:
• ABC - maintain airway, ensure breathing, cardiovascular resuscitation if necessary
• always give oxygen to prevent hypoxia
• assess cardiorespiratory function
• establish intravenous access 

• 2nd stage (0-30 min):
  • institute regular monitoring
• neurological observations
• measurements of pulse, blood pressure, temperature
• ECG, biochemistry, blood gases, clotting, blood count, drug levels
• emergency investigations aimed at determining the cause of the epilepsy
• hydration should be maintained with an intravenous infusion
• give emergency anticonvulsant medication (AED) (see section: drug regimen for details of anticonvulsant management)
• in suspected alcohol abuse or impaired nutrition administer
• glucose (50 ml of 50% solution) and/or intravenous thiamine (250 mg) as high potency intravenous Pabrinex
• treat acidosis if severe

• 3rd stage management (0-60 minutes) - established status:
• determine the cause of the epilepsy:
• consider MRI/CT scan
• lumbar puncture may be required but care must be taken that intracranial pressure is not raised and facilities for resuscitation should be available
• if stopping anticonvulsant treatment has precipitated status then the drug should be restarted
• alert anesthetist and ITU
• treat the complications of status, often hypotension necessitates the use of intravenous dopamine infusions
• continue anticonvulsant medication

• 4th stage management (60-90 minutes) - refractory status:
  • if seizures continue despite the above measures then the patient should be transferred to intensive care where they should be ventilated and anaesthetised
• aim for burst suppression on continuous EEG monitoring
• continuous intracranial pressure monitoring may be required
• longterm anticonvulsant medication is given in addition to the general anaesthetic agents (1)

References:

• (1) National Clinical Guideline Centre (NCGC) 2012. The Epilepsies. The diagnosis and management of the epilepsies in adults and children in primary and secondary care.