Status Epilepticus – snapshot

This, needless to say, is a medical emergency as it carries a significant risk of morbidity and a mortality in the order of 10% (sometimes less, often more):

• 30-minute definition: 30-day mortality rates for subjects with seizures lasting 10 to 29 minutes is 2.6% (GRMASE study)
• refractory status epilepticus: 19% mortality rate (in patients who otherwise had comparable clinical features)¹
  • Long‐term mortality after status epilepticus is seen in up to 20% of children and 55% of adults²

ABCs and DEFG (Don’t Ever Forget Glucose) 

1. Oxygen ± ventilate
2. 50 mL 50% Glucose bolus
3. Diazepam 10 mg IV or Infusion (200 mg in 1L 5% Dextrose in 24 hours)
   1. consider intranasal (or buccal) midazolam as first option
   2. rectal diazepam can also be used
4. Chlormethiazole 0.8% 40-100 ml over 5-10 minutes
5. may need to intubate (give muscle relaxant) and ventilate especially if > 60 minutes duration

References

1. Moghaddasi, Mehdi et al. “Evaluation of Short-term Mortality of Status Epilepticus and Its Risk Factors.” Journal of epilepsy research vol. 5,1 13-6. 30 Jun. 2015, doi:10.14581/jer.15003.
2. Sculier, Claudine et al. “Long-term outcomes of status epilepticus: A critical assessment.” Epilepsia vol. 59 Suppl 2,Suppl Suppl 2 (2018): 155-169. doi:10.1111/epi.14515.

Downloads

Status epilepticus – Emergency management in children – Flowchart (Qld Health)

Midazolam Versus Diazepam for the Treatment of Status Epilepticus in Children and Young Adults – McMullan (2010)

Management of Status Epilepticus – Durham (1999)

The Management of Status Epilepticus – Shorvon (2001)