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14 - Status Epilepticus

from Section 3 - Neurological Emergencies

Published online by Cambridge University Press:  02 November 2023

By
Matthew L. Wong
Edited by
Kaushal Shah  and
Jarone Lee
Edited in association with
Clark G. Owyang  and
Benjamin Christian Renne
Kaushal Shah
Affiliation:
Weill Cornell Medical Center, New York
Jarone Lee
Affiliation:
Massachusetts General Hospital, Boston
Clark G. Owyang
Affiliation:
Weill Cornell Medical Center, New York
Benjamin Christian Renne
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • In generalized convulsive status epilepticus (GCSE), a seizure lasts longer than 5 minutes or two seizures occur without an interval return to baseline.

  • The most common error in managing status epilepticus is not administering enough benzodiazepine. If the patient is refractory to benzodiazepines, there are multiple appropriate agents for second-line treatment (e.g., levetiracetam, valproate, fosphenytoin). A timely and early intubation may be the safest option and provide the best outcome for the patient.

  • Nonconvulsive status epilepticus (NCSE) presents without muscle involvement, and may be suspected clinically, but needs electroencephalography (EEG) to make the diagnosis.

Keywords

seizurebenzodiazepinesantiepilepticsEEG
Type
Chapter
Information
Practical Emergency Resuscitation and Critical Care , pp. 124 - 130
Publisher: Cambridge University Press
Print publication year: 2023

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References

Kapur, J, Elm, J, Chamberlain, J, et al. Randomized trial of three anticonvulsant medications for status epilepticus. N Engl J Med 2019;381(22):2103–2113. https://doi.org/10.1056/NEJMoa1905795CrossRefGoogle ScholarPubMed
Silbergleit, R, Durkalski, V, Lowenstein, D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med 2012;366:591–600.CrossRefGoogle ScholarPubMed
Treiman, DM, Meyers, PD, Walton, NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998;339:792–798.CrossRefGoogle ScholarPubMed

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