Clinical guideline: status epilepticus in children and adults

A generalized epileptic seizure lasting 5 or more minutes, or the presence of two or more seizures without recovering consciousness within 30 min, or a focal seizure that persists for >10 min, or with altered consciousness lasting for 60 min or more is called status epilepticus (SE). It can be classified into generalized and focal and motor and non-motor. Its etiology may or may not be recognized. The electroencephalographic pattern shows focal or generalized persistent epileptic activity. It is a dangerous situation, which requires algorithmic management from the time it is detected in the emergency room and if required, in intensive care. In-hospital management would include the initial ABCDE, hypertonic glucose solution, and thiamin; if hypoglycemia was detected. Lorazepam (midazolam [MDZ] or diazepam) to stop seizures, followed by phenytoin, valproate, or levetiracetam in impregnation and maintenance. If the SE persists for more than an hour, the patient will be admitted to an intensive care unit with intubation and continuous administration of MDZ, propofol or thiopental with continuous monitoring. If it does not yield with two drugs, it is called refractory epileptic status, and if it continues for 24 h or more, it is recognized as super-refractory. A third of patients die.