Status epilepticus and refractory status epilepticus management

Abstract

Status epilepticus (SE) describes persistent or recurring seizures without a return to baseline mental status and is a common neurologic emergency. SE can occur in the context of epilepsy or may be symptomatic of a wide range of underlying etiologies. The clinician's aim is to rapidly institute care that simultaneously stabilizes the patient medically, identifies and manages any precipitant conditions, and terminates seizures. Seizure management involves "emergent" treatment with benzodiazepines followed by "urgent" therapy with other antiseizure medications. If seizures persist, then refractory SE is diagnosed and management options include additional antiseizure medications or infusions of midazolam or pentobarbital. This article reviews the management of pediatric SE and refractory SE.

Figure 1

Status epilepticus evaluation and management pathway. Adapted from prior pathways.^–

Figure 2

Suggested Infectious Disease Evaluation for Children with Refractory Status Epilepticus (RSE). Adapted from prior tables.^,