Background: Dealing with a patient in status epilepticus, refractory to treatment with benzodiazepines, can be a sphincter tightening ordeal. While most seizure activity responds to appropriately dosed benzodiazipines, some will not respond. The choice of second line medication has been hotly debated (i.e. Levetiracetam, fosphenytoin, and valproate). One of the key aspects of management of status epilepticus is early termination. The longer the seizure continues, the more likely patients can have cardiac/respiratory complications, brain injury, rhabdomyolysis, hyperkalemia, and acidosis. Thus, prompt termination of seizure activity with second line agents is critical. Despite recent pediatric studies (ConSEPT, ECLIPSE etc) there is limited guidance on the efficacy or safety of second line mediations for status epilepticus....Read More
Definition: Seizure that has been going on for >5 minutes OR recurrent seizures without return to baseline. If the patient was seizing at home and still seizing when they get to the ED, consider it to be status.