Pharmacologic Management of Status Epilepticus

Status epilepticus (SE) is a neurological emergency defined as 5 minutes or more of continuous seizure activity or recurrent seizures without a return to baseline between seizures.¹  Previous definitions required seizure activity to last for at least 30 minutes before being considered SE. However, earlier intervention is required to reduce morbidity and mortality from permanent neuronal damage.²  Treatment of SE centers on rapid control of seizures with benzodiazepines in the emergent-control phase, followed by urgent-control therapy with intravenous antiepileptic drugs (AEDs) to prevent further seizures.³  Patients whose seizures do not respond to adequate urgent- and emergent-control therapy are considered to have refractory SE (RSE). The longer patients’ seizures last, the more difficult it is to terminate the seizures, often requiring multiple AEDs, intubation, and continuous-infusion anesthetic medications to achieve seizure termination.¹ 

Status epilepticus should be treated with rapidly administered, appropriately dosed benzodiazepines followed by intravenous AEDs....