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Management of the adult

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Seek expert guidance and consult local guidelines.

The protocol for treating convulsive status epilepticus in adults is as follows:

  • 1st stage (0-10 minutes) - early status:
    • ABC - maintain airway, ensure breathing, cardiovascular resuscitation if necessary
    • always give oxygen to prevent hypoxia
    • assess cardiorespiratory function
    • establish intravenous access
  • 2nd stage (0-30 min):
    • institute regular monitoring
    • neurological observations
    • measurements of pulse, blood pressure, temperature
    • ECG, biochemistry, blood gases, clotting, blood count, drug levels
    • emergency investigations aimed at determining the cause of the epilepsy
    • hydration should be maintained with an intravenous infusion
    • give emergency anticonvulsant medication (AED) (see section: drug regimen for details of anticonvulsant management)
    • in suspected alcohol abuse or impaired nutrition administer
      • glucose (50 ml of 50% solution) and/or intravenous thiamine (250 mg) as high potency intravenous Pabrinex
    • treat acidosis if severe
  • 3rd stage management (0-60 minutes) - established status:
    • determine the cause of the epilepsy:
      • consider MRI/CT scan
      • lumbar puncture may be required but care must be taken that intracranial pressure is not raised and facilities for resuscitation should be available
      • if stopping anticonvulsant treatment has precipitated status then the drug should be restarted
    • alert anesthetist and ITU
    • treat the complications of status, often hypotension necessitates the use of intravenous dopamine infusions
    • continue anticonvulsant medication
  • 4th stage management (60-90 minutes) - refractory status:
    • if seizures continue despite the above measures then the patient should be transferred to intensive care where they should be ventilated and anaesthetised
    • aim for burst suppression on continuous EEG monitoring
    • continuous intracranial pressure monitoring may be required
    • longterm anticonvulsant medication is given in addition to the general anaesthetic agents (1)

References:


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