Current treatment of status epilepticus

Generalized tonic-clonic status epilepticus is a relatively common neurologic emergency. The differential diagnosis of this condition includes decerebrate spasms and hysterical seizures. Initial therapy includes establishing an airway and securing an intravenous line. Blood should be obtained for chemistries and anticonvulsant levels. Administration of anticonvulsants should not be delayed until laboratory results are obtained. Intravenous diazepam will usually stop continuous tonic-clonic seizure activity, but because of a rapid redistribution phase, it necessitates administration of a longer acting anticonvulsant such as phenytoin or phenobarbital. Intravenous phenytoin should be administered slowly at a dose of 15 mg/kg while carefully monitoring vital signs. Intravenous phenobarbital produces sedation and may cause respiratory depression. Occasionally, other anticonvulsants such as paraldehyde, lidocaine, and general anesthesia will be needed to break status epilepticus. Careful follow-up of the patient and monitoring of the anticonvulsant levels may prevent future bouts of status epilepticus.