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Drug regimen for status epilepticus

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The emergency treatment for convulsive status epilepticus in the adult consists of the following:

  • premonitory stage (pre-hospital stage)
    • diazepam 10−20 mg rectally, repeated once 15 minutes later if status continues to threaten, or
    • midazolam 10 mg given buccally
    • if seizures continue, treat as below.
  • early status
    • lorazepam (intravenous) 0.1 mg/kg (usually a 4 mg bolus, repeated once after 10−20 minutes; rate not critical)
    • give usual AED medication if already on treatment
    • for sustained control or if seizures continue, treat as below
  • established status
    • phenytoin infusion at a dose of 15–18 mg/kg at a rate of 50 mg/minute or
    • fosphenytoin infusion at a dose of 15−20 mg phenytoin equivalents (PE)/kg at a rate of 50–100 mg PE/minute and/or
    • phenobarbital bolus of 10–15 mg/kg at a rate of 100 mg/minute.
  • reafractory status - the refractory stage (general anaesthesia) is reached 60/90 minutes after the initial therapy
    • general anaesthesia, with one of:
      • propofol (1–2 mg/kg bolus, then 2–10 mg/kg/hour) titrated to effect
      • midazolam (0.1–0.2 mg/kg bolus, then 0.05–0.5 mg/kg/hour) titrated to effect
      • thiopental sodium (3–5 mg/kg bolus, then 3–5 mg/kg/hour) titrated to effect; after 2–3 days infusion rate needs reduction as fat stores are saturated
      • anaesthetic continued for 12−24 hours after the last clinical or electrographic seizure, then dose tapered
    • in some instances, general anaesthesia should be initiated earlier and, occasionally, should be delayed (1)

Note:

  • emergency treatment of SE should be administered in parallel with AED therapy. The choice of drugs depends on the following factors:
    • previous therapy
    • the type of epilepsy
    • the clinical setting
  • any pre-existing AED therapy should be continued at full dose, and any recent reductions reversed (1)

Reference:


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