How is status epilepticus (SE) treated?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Aggressive treatment is necessary for status epileptics. Clinicians should not wait for blood level results before administering a loading dose of phenytoin, regardless of whether the patient is already taking phenytoin.

Pharmacotherapy

Most patients with status epilepticus who are treated aggressively with a benzodiazepine, fosphenytoin, and/or phenobarbital experience complete cessation of their seizures. If status epilepticus does not stop, general anesthesia is indicated.

Medications used in the treatment of status epilepticus include the following:

  • Benzodiazepines (eg, lorazepam, diazepam, midazolam): First-line agents

  • Anticonvulsant agents (eg, phenytoin, fosphenytoin)

  • Barbiturates (eg, phenobarbital, pentobarbital)

  • Anesthetics (eg, propofol)

Supportive therapy

Supportive care in patients with status epilepticus includes the following:

  • Maintenance of vital signs

  • Airway, breathing, circulation (eg, hemodynamic/cardiac monitoring)

  • Respiratory support, with intubation and/or mechanical ventilation if necessary

  • Periodic neurologic assessments

Surgery

Surgical intervention for status epilepticus is a last resort and rarely performed. [5, 6, 7, 8] Operative procedures depend on the etiology of this condition and may consist of ablating a structural abnormality, hemispherectomy, subpial resection, or placement of a vagus nerve stimulator.

See Treatment and Medication for more detail.


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