Status Epilepticus

Status Epilepticus

Blog written by Dr Ashly Liu

Definition

A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus. 

Approach to Management

Pharmacotherapy Options

Benzodiazepines (as per eTG)

• Clonazepam 1mg IV over 2-5 minutes. Repeat once 15 min later if ongoing status epilepticus
• Diazepam 10-20mg IV over 2-5 minutes. Repeat once 15 min later if ongoing status epilepticus
• Midazolam 5-10mg bolus IM, IV or buccally or intranasally
  • For IV, start 5mg bolus and onset 30s, then 2.5mg at 2-3min intervals. Once it hits 10-15mg, start considering other agents
  • For paediatric patients, 0.15mg/kg bolus

If the seizure continues for 10min despite benzodiazepines, further anticonvulsant loading is required.

Anti-epileptics

The following anti-epileptics have shown to be equally efficacious by the ESTT trial

• Phenytoin – 20mg/kg
  • Has increased associated risk of bradyarrhythmia and hypotension
• Sodium valproate – 20mg/kg (max 3000mg)
  • Risks: avoid in pregnancy
• Levetiracetam – 60mg/kg (max 4500 mg)
  • Preferred in pregnancy

If refractory, RSI and propofol as the last line to terminate the seizure

Sources: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/neurology/seizures/seizure-medications