1. Status Epilepticus-Definition
1. Major motor (convulsive) status
Three(3) seizures uninterrupted by consciousness or a single prolonged seizure greater than 1/2 hour.
2. Spike wave stupor (Absence or Petit mal status) and complex partial (psychomotor) status are prolonged alterations of consciousness verified by EEG as epileptic.

2. Status epilepticus
It is a medical emergency – requires prompt and aggressive treatment
Therapy should be aimed at:
Rapid termination of status epilepticus
Prevention of seizure recurrence
Treatment of underlying cause

3. Status Epilepticus - Treatment
Immediate treatment
1. Secure IV line draw blood for analysis (including anticonvulsant levels).
2. Push 50 cc of 50% Dextrose i.v.,
100mg thiamine i.v.
3. Monitor vital signs.
4. Examine patient.
5. Protect airway, tongue, head, never leave patient alone
6. Intubate all patients if first line drugs fail.

4. Status Epilepticus - Definite Treatment
Non-specific
Correct electrolyte imbalance - acidosis lowers seizure threshold, treat with bicarbonate if pH<7.1
Lower fever
Antibiotics/ LP if indicated
If neurologic exam dictates, treatment of underlying cause may proceed concurrently with drug therapy, e.g., neurosurgical decompression.
Hypotension – maintain BP

5. Status Epilepticus-Definitive Treatment
Diazepam - 10mg IV push over seconds repeat after 10-15mins upto 30mg (5mg/min) Repeat after 2-4hrs. 100mg/day
i.Good results, easy to administer. (fast acting, short lasting)
ii. If two doses fail to stop status, then further doses probably won't work either.
iii. Side effects -- hypotension, bradycardia, respiratory depression, cardiac arrest, depresses mental status.

6. OR
Lorazepam - 4 mg IV push (2mg/min) may be repeated.
i. Fast acting, medium lasting.
ii. Respiratory depression only in the extubated patient.

7. Status Epilepticus-Definite Treatment
b. Phenytoin mg/kg IV (slow IV push) (50mg/min) fast and long acting.
i. Presently used concomitantly with a benzodiazepine
ii. Its pH is 12, all i.v. fluids are pH 4-6. Do not add to dextrose drip as it preciptiates.
iii. Monitor BP and ECG

8. IV Valproate - 25 mg/kg IV push, may repeat.
i. Generally not used because of lack of experience. Good results in both major motor and absence status.
ii. fast acting, long acting.
iii. Far less side effects than Diazepam and dilantin especially in unstable cardiac status, hypotension, hepatic failure etc.

9. Status Epilepticus - Definite Treatment
Other drugs that can be used:
IV Midazolam, IM fosphenytoin
IM paraldehyde
In children and when venous access unavailable, rectal diazepam, lorazepam, midazolam or paraldehyde.
IV thiopentone, IV lignocaine, IV propofol.
Neuro muscular blocking agents