Treatment of Status Epilepticus

This is the treatment of a long seizure that does not remit. How long? Well different sources say different times, but they range between 10 and 30 minutes. Regardless, any prolonged seizure needs to be stopped to prevent catastrophic complications. Drugs of choice...

1. Benzodiazapines: first line. Lorazepam and Diazepam are the most widely used agents. Lorazepam is favoured because it is less lipid soluble and may paradoxically have higher serum levels for a prolonged time. Excellent in breaking most seizures.

2. Phenytoin: this is next on your armamentarium. This is more useful in preventing further seizures than in stopping the current one. You can load a patient IV or PO. Caution with IV - you need cardiac monitoring and can induce a profound hypotension. Infuse slowly. Fosphenytoin is a pro-drug of phenytoin and can be infused much more rapidly.

3. Barbiturates: eg. Phenobarbital. If you are getting to this point, the ICU should be well involved.

4. Propofol: again, this is not for the medicine wards...the ICU will be caring for these patients.

Check out this NEJM article for the evidence behind our choices of treatment: http://content.nejm.org/cgi/content/full/339/12/792