Status epilepticus is defined as:

• a single seizure lasting >5 minutes, or

• = 2 seizures within a 5-minute period without the person returning to normal between them

This is a medical emergency. The priority is the termination of seizure activity, which if prolonged will lead to irreversible brain damage.

Investigations

Bedside:

• Oxygen sats and glucose

Labs:

• ABG
• Routine bloods - FBC, UandE, LFT, CRP, calcium, magnesium
• clotting screen
• antiepileptic drug levels

Management

• A to E

  • airway adjunct
  • oxygen
  • check blood glucose

  *Rapid assessment of hypoxia and hypoglycaemia can rule out two easily treatable causes of status epilepticus.

• First-line drugs are IV benzodiazepines such as diazepam or lorazepam

  • in the prehospital setting PR diazepam (10-20mg) or buccal midazolam (10mg) may be given
  • in hospital IV lorazepam is generally used (0.1mg/kg - usually a 4mg bolus). This may be repeated once after 10-20 minutes

• If ongoing (or 'established') status it is appropriate to start a second-line agent such as phenytoin (15–18 mg/kg at a rate of 50 mg/minute) or phenobarbital infusion (10–15 mg/kg at a rate of 100 mg/minute)

• If no response ('refractory status') within 45 minutes from onset, then the best way to achieve rapid control of seizure activity is induction of general anaesthesia.