SHM's Clinical Quick Talks-Acute Inpatient Management of Status Epilepticus

Pdf Summary

The document outlines acute inpatient management of Status Epilepticus (SE), a neurological emergency defined by seizures lasting ≥5 minutes or recurrent seizures without regaining baseline consciousness. SE risks include neuronal injury, systemic complications, and death, necessitating prompt treatment.<br /><br />Reversible causes are categorized as metabolic (e.g., hypoglycemia, hyponatremia), toxic/drug-related (e.g., alcohol withdrawal, drug overdose), infections (meningitis, encephalitis), structural (stroke, brain tumor), withdrawal syndromes, and others like hypoxia or fever.<br /><br />Initial management emphasizes airway, breathing, and circulation stabilization. First-line treatment involves weight-based benzodiazepines—Lorazepam IV, Diazepam IV, or Midazolam IM (if no IV access). Simultaneously, key labs (glucose, electrolytes, renal/liver function, toxicology) and imaging (stat CT brain) should be obtained.<br /><br />If seizures persist beyond 10 minutes, second-line antiepileptics such as fosphenytoin, levetiracetam, or valproate are administered. Continuous EEG monitoring is essential to detect ongoing or non-convulsive SE and guide treatment effectiveness.<br /><br />For refractory SE, ICU admission is necessary for continuous sedation with agents like midazolam or propofol. Supportive care includes airway management, correction of metabolic derangements, and multidisciplinary consultations (neurology, infectious disease, toxicology).<br /><br />Key clinical pearls stress urgency—treat seizures lasting >5 minutes promptly, avoid underdosing benzodiazepines, continuously monitor EEG, and diligently investigate reversible causes. Differential diagnoses include syncope, psychogenic seizures, and metabolic encephalopathies. Early identification and intervention are critical to improve outcomes.<br /><br />In summary, the acute management strategy prioritizes stabilization, rapid benzodiazepine administration, second-line antiepileptics if seizures continue, continuous EEG monitoring, and escalation to ICU care for refractory cases, coupled with thorough diagnostic evaluation to address underlying causes.

Asset Subtitle

Zain Abidin, Nicole Terrigno

Keywords

Status Epilepticus

acute inpatient management

benzodiazepines

lorazepam

diazepam

midazolam

second-line antiepileptics

fosphenytoin

levetiracetam

continuous EEG monitoring