STATUS EPILEPTICUS

Persistent seizure >5minutes or recurrent seizures without return to consciousness in 5 minutes

Initial Treatment

  • Lorazepam (preferred over diazepam because longer t1/2 of distribution in CNS): 2-4 mg IV every 10-15 minutes (maximum dose 12mg)
  • Fosphenytoin: 20 PE/kg IV at a rate of 150 PE/min or Phenytoin: 20 mg/kg at a rate of 50 mg/minute

Refractory Status Epilepticus

Failure to respond to optimal benzodiazepine and phenytoin (or fosphenytoin) loading after 20 minute. Requires intubation and recommend EEG monitoring

  • Phenobarbital: 20 mg/kg IV bolus over 50mg/min

 

  • Propofol: Loading dose @ 2 mg/kg bolus followed by drip @ 1 mg/kg/hr (titrate) to goal of seizure cessation
  • Midazolam: Loading dose: 0.2 mg/kg bolus (maximum 10mg bolus) followed by drip @ 0.2 mg/kg/hr to goal of seizure cessation

Additional considerations

  • Valproic Acid
  • Levetiracetam
  • Consider hypoglycmia, toxic ingestions (dilantin of little value), eclampsia in the pregnant patient