This document discusses the current guidelines for the management of status epilepticus. It defines status epilepticus as more than 30 minutes of continuous seizure activity or two sequential seizures without full recovery. Status epilepticus can be convulsive or nonconvulsive. The goal of therapy is rapid termination of seizures to reduce mortality and morbidity. Treatment involves several phases based on duration of seizures. Initial therapy within 20 minutes involves benzodiazepines like midazolam or lorazepam. Later phases involve other drugs like propofol or thiopental if seizures continue beyond 40 minutes.

1. Status Epilepticus- current
management
Dr. Rahat Mahmood
PGR Medicine

2. Subjectives
• Definition
• Types
• Etiology
• Management according to guidelines

3. Evidence based guideline:
Treatment of Convulsive Status
Epilepticus in adults
American Epilepsy Society, 2016

4. • Status epilepticus is defined as more than 30 minutes of
either continuous seizure activity or
• two or more sequential seizures without full recovery
of consciousness between seizures.
Definition

5. • Status epilepticus presents in several forms:
• 1) convulsive status epilepticus consisting of repeated
generalized tonic–clonic (GTC) seizures
• 2) nonconvulsive status epilepticus means
persistent absence seizures or focal seizures with
confusion or partially impaired consciousness and
minimal motor abnormalities.
Types

6. • The goal of therapy is the rapid termination of both
clinical and electrical seizure activity, since
appropriate and timely therapy of status epilepticus
reduces the associated mortality and morbidity.
• The prognosis is most strongly related to the etiology,
duration of status epilepticus, and the age of the
patient.
Goal of therapy

9. Key steps in management
Stabilization phase (0-5 minutes of seizure activity), includes
standard initial first aid for seizures and initial assessments and
monitoring.
Initial therapy phase (5-20 minutes of seizure activity) when it is
clear the seizure requires medical intervention, a benzodiazepine
(specifically IM midazolam, IV lorazepam, or IV diazepam) is
recommended as the initial therapy of choice, given its
demonstrated efficacy, safety, and tolerability.
Second therapy phase (20-40 minutes of seizure activity) when
response (or lack of response) to the initial therapy should be
apparent.
Third therapy phase (40+minutes of seizure activity).

13. • Dose of midazolam infusion-0.2 mg/kg IV bolus in 2 min
followed by 0.1-0.4 mg/kg/hr continuous infusion
• Propofol infusion 2-5mg/kg IV bolus followed by 5-10
mg/kg/hr continuous infusion
• Thiopental infusion 10-20mg/kg IV bolus followed by
0.5-1 mg/kg/hr IV infusion.

15. Thank you