Initial Management of Acute Seizures and Status Epilepticus

Status epilepticus is a time-sensitive neuro-emergency, linked to poor functional outcomes and higher mortality rates. Prompt diagnosis and treatment are crucial to reduce its morbidity and mortality. Status epilepticus is often underdiagnosed in acutely ill hospitalized patients with altered consciousness, in whom most ongoing seizures can be subtle or nonconvulsive. For unexplained, persistent altered consciousness, clinicians should use electroencephalography to confirm or exclude a diagnosis of status epilepticus. A standardized treatment protocol should include prompt and adequately dosed first benzodiazepines as line therapy. Treatment approaches for second-line and third-line management continue to evolve as new anti-seizure medications become available.