Status Epilepticus

Clinical Description

Continuous seizure activity or seizures without recovery of consciousness for > 30 minutes.

In 2015, the international league against Epilepsy (ILAE) recommended a definition which defines any seizure activity >5 minutes as status epilepticus. This new definition necessitates early vigilance in management of prolonged seizures which may lead to good outcomes. This is an emergency and mortality is high.

Non-pharmacological

• Clear the airway, insert IV-line, position patient in recovery position
• Do not insert any object between the teeth

Pharmacological

Adults

• Give Diazepam 5-10 mg IV. Repeat the dose if seizures recur and give loading dose of antiepileptic medications.
• Give phenytoin 15 -18 mg/kg (600- 1200 mg) IV. Dilute with 100 ml normal saline and give slowly, no more than 50 -100 mg/minute.
• Or phenobarbitone 10 -15 mg/kg dilute with water for injection 1:10 and give slowly, no more than 100 mg/minute.
• Check blood sugar. Give glucose, if suspicious of hypoglycaemia
• Give Thiamine 100mg IV or IM once daily before giving glucose if patient suffers from alcoholism.
• If still no improvement, consider general anaesthesia (in ICU setting preferably).
• Antiepileptic medications can be prescribed for further control of the seizures.

Complications and Referral Criteria

If the patient is being managed at a Health Centre level, referral must be done once the patient has been loaded with either phenytoin or phenobarbitone to facility which has anesthetist’s care.