Affiliation:
1. Drug Information Analysis Service, School of Pharmacy, and the Department of Neurology, School of Medicine, University of California, San Francisco, CA
Abstract
Status epilepticus is a medical emergency that requires prompt intervention with effective anticonvulsant drug therapy to minimize the risk of morbidity and mortality. Although status epilepticus can occur as the first presentation of seizures, it is more common in patients who have a history of epilepsy. Metabolic disturbances, stroke, infection, and head trauma can also precipitate repetitive or continuous seizures and, if possible, the underlying etiology should be corrected as the first step in effective management. Permanent neurological sequelae are more likely as the duration of status epilepticus exceeds 90 minutes. In this regard, it is essential that anticonvulsant drug therapy is initiated as soon as possible. Benzodiazepines (diazepam, Iorazepam) are commonly used as the agents of choice for early termination of status epilepticus. Phenytoin and phenobarbital are also useful because of their long-lasting anticonvulsant effects. Other agents that may be useful under special circumstances include midazolam, fosphenytoin (phenytoin prodrug), sodium valproate, paraldehyde, and high-dose barbiturates.