Introduction

  • Simple seizure
    • Seizure ends in <5 minutes AND
    • Patient wakes up before next seizure
      • No meds required
  • Status epilepticus
    • Seizure lasts >5 minutes OR
    • Patient has a 2nd seizure before waking up from 1st
      • Initiate status epilepticus pathway

Approach to Status Epilepticus

  • Step 1: Give a benzodiazepine
    • Lorazepam (IV)
    • Diazepam (IV or PR)
    • Midazolam (IV or IM)
  • Step 2: Give an anti epileptic
    • Levetiracetam (Keppra)
    • Fosphenytoin
    • Valproic Acid
  • Step 3: Continue attempting agents for 30 minutes
    • If seizure continues, you must move onto step 4…
  • Step 4: Sedate and intubate the patient
    • Propofol
    • Phenobarbital
  • Step 5: Start patient on continuous EEG
    • Detects non-convulsive status epilepticus
    • Usually started once patient is in ICU

Additional Reading