Management of status epilepticus

Status epilepticus is a medical emergency, if not treated in time and effectively may cause significant mortality and morbidity. Medical therapy has been the mainstay of treatment but in refractory status surgical resection, multiple subpial transection, electroconvulsive therapy, caudate stimulation and acupuncture play important role. The present operational definition for adults and older children considers status as > or = 5 minutes of continuous seizure or two or more discrete seizures without regaining of full consciousness. Status epilepticus accounts for 1-8% of all hospital admissions for epilepsy. Physiological changes in generalised convulsive status epilepticus include transient or early (0-30 minutes) and late (after 30 minutes) changes. Temporal changes occur as tonic-clonic status epilepticus progresses. Management can be considered in two ways--out hospital management and inpatient management. Benzodiazepine is considered 1st line of treatment outside hospital. Emergency/inpatient management includes basic life support (0-10 minutes) and pharmacological management (10-60 minutes). Drugs used in pharmacological management are lorazepam, midazolam, propofol, phenobarbital, phenytoin, fosphenytoin, i.v. valproate, rectal diazepam, etc. The classical definition of refractory status epilepticus includes seizure that has not responded to sequential treatment of lorazepam, phenytoin or phenobarbitone or seizure continuing > 60-90 in spite of adequate treatment.