Status epilepticus is a life-threatening neurological condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness.

Aetiology:

Causes of status epilepticus include infection, an underlying neurologic disorder like a cerebral malformation, and metabolic or electrolyte disturbances like hypocalcemia, hyponatremia or hypoglycemia.

Management

This applies to an inpatient setting

• Roll on side (if safe to do so) + high-flow oxygen + check glucose
• First line treatment if seizure not resolved within 5 minutes: IV lorazepam or buccal midazolam or rectal diazepam
• If seizure is continuing after 10 minutes: IV lorazepam (2nd dose)
• If seizure continues for another 10 minutes: IV lorazepam; call for senior support, including anaesthesia if not already done so
• If seizure continues after another 5 minutes: IV levetirecatem as a second line agent (faster acting than Phenytoin)
• If seizure continues after another 10 minutes: Phenytoin over 20 mins (IV phenobarbitone if patient normally takes phenytoin) OR Rapid sequence induction with sodium thiopentone

Complications

Diagnosis of non-convulsive status epilepticus can be difficult, but recognition is crucial because rapid termination helps to prevent serious brain injury, especially in patients with impaired consciousness. In most cases, treatment must precede any thorough investigation and must be initiated as soon as status epilepticus is suspected.

Complications of status epilepticus:

• Focal neurological deficit (normally temporary)
• Memory loss