Status epilepticus: recent trends and prospects

Mechanisms of brain damage subserving chronic impairment of recent memory and a rationale for terminating convulsive status epilepticus within 60 minutes is discussed. Available first agent regimens (diazepam plus phenytoin, lorazepam alone, barbiturates alone, and phenytoin alone) and the properties of the ideal drug for status epilepticus will be reviewed. A new updated protocol is presented considering the type of status and EEG characteristics. Primary tonic-clonic or clonic-tonic-clonic status, with 8 Hz diffuse sharp rhythms or 2-5 Hz spike or multispike wave complexes and secondary tonic-clonic status with focal 12-18 Hz spikes spreading diffusely can receive intravenous lorazepam as the first agent. Complex partial status and absence status can also receive lorazepam as the first agent. Tonic status and atypical absence status can be treated with phenytoin infusion or rectal sodium valproate. Convulsive status which do not respond to available first agent regimens should be terminated by barbiturate of fluothane general anesthesia.