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Status Epilepticus: Evidence and Controversy

García Peñas, Juan José MD*†; Molins, Albert MD; Puig, Javier Salas MD§

doi: 10.1097/NRL.0b013e31815bb069
Review Article

Status Epilepticus (SE) is a potential and relatively common complication of epileptic seizures. Traditionally, SE was defined as 30 minutes of continuous seizure activity or a series of seizures without return to full consciousness between the seizures. As a practical rule, it is admitted that all patients arriving at the emergency room suffering from epileptic seizures could have SE and should be treated accordingly. It is well known that the longer an attack has lasted, the more difficult it is to control in the next 5 to 10 minutes. On the other hand, once an attack has lasted for over 5 to 10 minutes, it is unlikely to cease spontaneously. Ambulatory intervention should focus on this “therapeutic interval” in acute attacks with the use of first-line drugs such as the intramuscular, rectal, oral, and/or intranasal application of benzodiazepines (BZD).

Treatment of SE is a medical emergency, which should include 3 priority objectives: (1) to stop the seizures; (2) to maintain internal homeostasis; and (3) to treat possible complications. Current consensus is that a BZD, notably lorazepam or diazepam, is the initial class of drug for the treatment of SE. Phenytoin, fosphenytoin, or valproate generally is agreed upon as the next drugs to be administered. Failure to respond to optimal BZD and phenytoin loading operationally defines refractory SE.

From the *Refractory Epilepsy Unit, Section of Pediatric Neurology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; †Universidad Autónoma de Madrid, Madrid, Spain; ‡Epilepsy Unit, Section of Neurology, Hospital Universitario Doctor Josep Trueta, Gerona, Spain; and §Epilepsy Unit, Service of Neurology, Hospital Central de Asturias, Oviedo, Spain.

Reprints: Dr. Juan José García Peñas, Unidad de Epilepsia Refractaria, Sección de Neurología Pediátrica, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo-65, 28009-Madrid, Spain. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.