nil

1. Status Epilepticus- current
management
Dr. Rahat Mahmood
PGR Medicine

2. Subjectives
• Definition
• Types
• Etiology
• Management according to guidelines

3. Evidence based guideline:
Treatment of Convulsive Status
Epilepticus in adults
American Epilepsy Society, 2016

4. • Status epilepticus is defined as more than 30 minutes of
either continuous seizure activity or
• two or more sequential seizures without full recovery
of consciousness between seizures.
Definition

5. • Status epilepticus presents in several forms:
• 1) convulsive status epilepticus consisting of repeated
generalized tonic–clonic (GTC) seizures
• 2) nonconvulsive status epilepticus means
persistent absence seizures or focal seizures with
confusion or partially impaired consciousness and
minimal motor abnormalities.
Types

6. • The goal of therapy is the rapid termination of both
clinical and electrical seizure activity, since
appropriate and timely therapy of status epilepticus
reduces the associated mortality and morbidity.
• The prognosis is most strongly related to the etiology,
duration of status epilepticus, and the age of the
patient.
Goal of therapy

9. Key steps in management
Stabilization phase (0-5 minutes of seizure activity), includes
standard initial first aid for seizures and initial assessments and
monitoring.
Initial therapy phase (5-20 minutes of seizure activity) when it is
clear the seizure requires medical intervention, a benzodiazepine
(specifically IM midazolam, IV lorazepam, or IV diazepam) is
recommended as the initial therapy of choice, given its
demonstrated efficacy, safety, and tolerability.
Second therapy phase (20-40 minutes of seizure activity) when
response (or lack of response) to the initial therapy should be
apparent.
Third therapy phase (40+minutes of seizure activity).

13. • Dose of midazolam infusion-0.2 mg/kg IV bolus in 2 min
followed by 0.1-0.4 mg/kg/hr continuous infusion
• Propofol infusion 2-5mg/kg IV bolus followed by 5-10
mg/kg/hr continuous infusion
• Thiopental infusion 10-20mg/kg IV bolus followed by
0.5-1 mg/kg/hr IV infusion.

15. Thank you