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Hirsch, Lawrence, J.; Arif, Hiba

CONTINUUM: Lifelong Learning in Neurology: August 2007 - Volume 13 - Issue 4, Epilepsy - p 121-151
doi: 10.1212/01.CON.0000284538.29811.da

Status epilepticus (SE) is a medical emergency. It requires prompt diagnosis and treatment since delay is associated with worse outcome and a higher likelihood of poor response to treatment. Lorazepam is well established as first-line therapy. Rectal diazepam or nasal or buccal midazolam should be given if IV access is not immediately available. This is usually followed by phenytoin or fosphenytoin. SE may be either convulsive or nonconvulsive; the nonconvulsive form remains underdiagnosed. Urgent EEG is indicated in any patient with fluctuating or unexplained alteration of behavior or mental status, and after convulsive seizures or SE if the patient does not rapidly awaken. For refractory SE, continuous IV midazolam and propofol, separately or in combination, are rapidly effective.

© 2007 American Academy of Neurology
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