What are the AES guidelines on the treatment of status epilepticus (SE)?

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

In 2016, the American Epilepsy Society (AES) issued new guidelines for the treatment of SE. The guidelines provide a time-dependent treatment algorithm that includes four phases. [62]

In the stabilization phase, standard first-aid for seizures should be initiated.

In the initial therapy phase, a benzodiazepine (specifically IM midazolam, IV lorazepam, or IV diazepam) is recommended as initial therapy.

In the second phase, options include IV fosphenytoin, valproic acid, or levetiracetam. If none of these is available, IV phenobarbital is a reasonable alternative.

In the third phase, if a patient experiences 40+ minutes of seizure activity, treatment considerations should include repeating second-line therapy or anesthetic doses of thiopental, midazolam, pentobarbital, or propofol.

 


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