Status epilepticus: there were many causes, drugs used and diagnostic studies performed.

Clinical bottom line (level 5)

  1. The working group recommends a clear plan, prompt treatment and awareness of possible side effects.
  2. In adults, cerebrovascular causes were the main precipitating factor, followed by ethanol/ drug-related causes and anoxia.
  3. Main drugs used are diazepam, lorazepam, phenytoin and phenobarbital.
Working Group on Status Epilepticus : Journal of the American Medical Association 1993; 270 (7): 854-859
Expires December 2003

The study

Systematic review of non-systematic review, using any article of
  • Patients: convulsive status epilepticus
  • Outcome: mortality and morbidity


    • Articles found in ? languages using MEDLINE, M-Base and the National Epilepsy Library database, ? dates (search terms: not stated )

    Selection criteria: not stated
    Appraisal criteria: not stated
    Articles excluded if: not stated


    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    cause in children 16 years old or less: fever/ infection ? / 36%
    (% to %)
    medication change ? / 20%
    (% to %)
    metabolic ? / 8.2%
    (% to %)
    congenital ? / 7.0%
    (% to %)
    anoxia ? / 5.3%
    (% to %)
    other ? / 11%
    (% to %)
    unknown ? / 9.3%
    (% to %)
    medication change ? / 19%
    (% to %)
    cause in adults over 16: cerebrovascular ? / 25%
    (% to %)
    ethanol/ drug-related ? / 12%
    (% to %)
    anoxia ? / 11%
    (% to %)
    metabolic ? / 8.8%
    (% to %)
    other ? / 16%
    (% to %)
    unknown ? / 8.1%
    (% to %)

    • About half of the status epilepticus cases occur in young children
    • Consider:
      • airway and oxygenation
      • glucose
      • blood pressure
      • fluids
      • electrolyte levels and other blood studies
      • body temperature
    • Major drugs used for treatment are diazepam, lorazepam, phenytoin, phenobarbital.
    • Diazepam:
      • adult dose 0.15-0.25 mg/kg
      • child dose 0.1-1.0 mg/kg
      • max. administration rate 5 mg/min
      • time to stop status 1-3 mins
      • effective duration of action 0.25-0.5 hours
      • side effects: depression of consciousness 10-30 mins, occasional respiratory depression
    • lorazepam:
      • adult dose 0.1 mg/kg
      • child dose 0.05-0.5 mg/kg
      • max. administration rate 2.0 mg.min
      • time to stop status 6-10 min
      • effective duration of action >12-24 hours
      • side effects: depression of consciousness several hours, occasional respiratory depression
    • phenytoin:
      • adult dose 15-20 mg/kg
      • child dose 20 mg/kg
      • max. administration rate 50 mg/min
      • time to stop status 10-30 mins
      • effective duration of action 24 hours
      • side effects: occasional hypotension, cardiac arrhythmias in patients with heart disease
    • phenobarbital:
      • adult dose 20 mg/kg
      • child dose 20 mg/kg
      • max. administration rate 100 mg/min
      • time to stop status 20-30 mins
      • effective duration of action >48 hours
      • side effects: depression of consciousness for several days, occasional respiratory depression
    • in absence of coexisting acute brain insult, prompt and appropriate treatment is usually associated with a favourable outcome.
    • Initial diagnostic studies:
      • glucose, electrolytes, BUN
      • oximetry or arterial blood gases
      • antiepileptic drug levels
      • lumbar puncture
      • complete blood count
      • urinalysis
    • Second-phase diagnostic studies:
      • liver function studies
      • toxicology screen
      • EEG
      • brain imaging with CT or MRI scan

    Citation

    1. Working Group on Status Epilepticus , : Treatment of convulsive status epilepticus: Recommendations of the Epilepsy Foundation of America's Working Group on Status Epilepticus. Journal of the American Medical Association 1993; 270 (7): 854-859
    Contributor: Clare Wotton and Bob Phillips, December 2000
    Reviewer:

    Clinical Question.
    Patient convulsive status epilepticus
    Intervention or Exposure treatment
    Outcome recovery