Status Epilepticus Management: A Short Review

Status epilepticus is a common neurological emergency, with high morbidity and mortality, now defined as 5 minutes or more of (1) continuous clinical and/or electrographic seizure activity or (2) recurrent seizure activity without recovery (returning to baseline) between seizures. In observational studies, many disparities exist in management among different medical teams. Here, the author reviews evidence-based medicine data on this management, with emphasis on the use of drugs and electroencephalography. Benzodiazepine (either IV lorazepam or IM midazolam) are the recognized first line of treatment. When a patient is still seizing thereafter, the second line is usually either IV phenytoin or IV valproate, where available. A persisting status epilepticus should then be considered as refractory and managed with anaesthetic drug, keeping in mind that the natural history of that state is to evolve to nonconvulsive status epilepticus, where an emergent EEG is the only way to diagnose that condition with certainty.