Emergent Management of Status Epilepticus.
Continuum (Minneapolis, Minn.) June 1, 2024 Clio Rubinos 6 citations
Status epilepticus is a life-threatening neurologic emergency requiring prompt recognition and treatment. Management follows a patient-specific framework based on semiology, etiology, EEG correlate, and age. Benzodiazepines are first-line treatment, supported by three randomized controlled trials in hospital and prehospital settings, and can be given intravenously, intramuscularly, rectally, or intranasally. If seizures persist, second-line options include phenytoin, fosphenytoin, valproate, or levetiracetam; the Established Status Epilepticus Treatment Trial found all three similarly effective in about half of patients. Refractory cases require IV anesthetics like ketamine or GABA-ergic medications. Evidence increasingly supports ketamine use early in stage 3 status epilepticus and as a second-line option. Prompt antiseizure medication is critical because 'time is brain.'