Table of contents
Status epilepticus
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of status epilepticus are prepared by our editorial team based on guidelines from the World Health Organization (WHO 2023), the American Epilepsy Society (AES 2016), the The Scottish Intercollegiate Guidelines Network (SIGN 2015), the Neurocritical Care Society (NCS 2012), and the European Federation of Neurological Societies (EFNS 2010).
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Screening and diagnosis
Classification and risk stratification
Classification
As per NCS 2012 guidelines:
Classify SE as either:
convulsive SE: convulsions associated with rhythmic jerking of the extremities
non-convulsive SE: seizure activity seen on EEG without the clinical findings associated with convulsive SE
A
Define refractory SE as SE not responding to the standard treatment regimens, such as an initial benzodiazepine followed by another antiepileptic drug.
B
Diagnostic investigations
Initial evaluation
As per SIGN 2015 guidelines:
Obtain EEG to establish the diagnosis of SE and to monitor for treatment effect. Ensure that EEG is available as an emergency intervention in all patients with treated or suspected SE.
B
Do not deter or delay treatment in patients with SE because of nonavailability of EEG. B
Obtain CBC, urea and electrolytes, LFTs, calcium, glucose, clotting, measurement of antiepileptic drug levels, and store the collected blood for later tests. Measure blood gases to assess the extent of acidosis.
B
Medical management
More topics in this section
Initial management
Antiepileptic drugs (emergent therapy)
Antiepileptic drugs (urgent therapy)
Management of refractory SE