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Status epilepticus

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

Reference:


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