6th August 2024

Status epilepticus

Status epilepticus is a medical emergency defined as a seizure lasting more than 5 minutes or recurrent seizures without recovery in between.

Patients should be treated with a benzodiazepine (IV preferred, buccal or rectal if no IV route available) after the first 5 minutes and then re-treated after 5 minutes if the seizure does not terminate. If this is ineffective, second line agents (anti-epileptic drugs: levetiracetam, phenytoin, or valproate) should be given. Patients for whom this is ineffective will require general anaesthesia with intubation and ventilation.

Status epilepticus may be non-convulsive – the patient may appear to be simply comatose with no other explanation. There may be limited or subtle features to point towards this diagnosis, though examination may reveal, for example, subtle twitching or eye movement abnormalities. EEG confirmation is required.