Which medications in the drug class Benzodiazepines are used in the treatment of Status Epilepticus?

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

Benzodiazepines

These are first-line agents for treating SE. They rapidly achieve therapeutic CNS concentrations after IV administration and act to potentiate action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the CNS, and rapidly abrogate ongoing seizure activity. Their effect is temporary, which is a limitation; diazepam begins to redistribute out of CNS within minutes. Lorazepam, when available, is thought to be the most effective and has a longer seizure half-life than diazepam. Because the effect is time limited, loading of a traditional AED, such as phenytoin, is recommended soon after administration to help mitigate seizure recurrence.

Lorazepam (Ativan)

Lorazepam is preferred by most neurologists for treatment of SE because of its more prolonged CNS action. It is less fat-soluble than diazepam and therefore takes slightly longer (5-10 min) to stop seizures. It has a smaller volume of distribution than diazepam. Serum concentrations reach 50% of Cmax at 20 min. Lorazepam clears from the brain slower than diazepam but loses protective effect over 30-120 min.

It is important to monitor the patient's blood pressure after administering a dose. Adjust as necessary.

Diazepam (Diastat, Valium)

Diazepam is an extremely lipid-soluble agent that quickly enters the brain in first pass and often stops seizures in 1-2 min. It rapidly distributes to other stores of body fat. Its serum concentration decreases to 20% of maximum concentration (Cmax) 20 min after IV infusion. Individualize dosage and increase cautiously to avoid adverse effects.

Midazolam (Versed)

Midazolam is used as an alternative agent in termination of refractory SE. Because midazolam is water soluble rather than fat soluble, it takes approximately 3 times longer than diazepam to peak EEG effects. Thus, the clinician must wait 2-3 min to fully evaluate sedative effects before repeating a dose.


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