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status epilepticus

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The Commission on Classification and Terminology of the International League Against Epilepsy (ILAE) defines Status Epilepticus as:

“a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur” (1).
There is no clear definition on the time period which a convulsion has to last before being classified as status epilepticus (SE) (2)

  • originally, the ILEA defined SE as 30 minutes of sustained seizure activity or 2 or more seizures during this time period without a return to the baseline level of consciousness between  seizures (2)
    • animal data have indicated that more than 30 minutes of continuous seizure activity may result in permanent neuronal injury and pharmacoresistance (3)  
  • Lowenstein and colleagues have proposed a definition of SE based on seizures which are longer than 5 minutes or two or more discrete seizures without a return of consciousness between seizures (4) 

Status epilepticus is a medical emergency because of the 20% mortality and the high rates of neurological and systemic morbidity. Prolonged generalized SE can lead to death or permanent brain damage (5).

Prolonged or repeated seizures and convulsive status epilepticus

  • buccal midazolam or rectal diazepam should only be prescribed for use in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures
  • administer buccal midazolam as first-line treatment in children, young people and adults with prolonged or repeated seizures in the community
    • administer rectal diazepam if preferred or if buccal midazolam is not available
    • if intravenous access is already established and resuscitation facilities are available, administer intravenous lorazepam

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Last edited 09/2018

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