Epilepsy - Treatment

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Treatment of Status Epilepticus

The treatment goals of status epilepticus are:

• Stop the seizures
• Prevent recurrence
• Determine and prevent any factors that might have triggered it
• Manage any complications

Initial Management. The earlier a patient is treated, the better the results. In one study, seizures stopped in 80% of patients who were treated within 30 minutes. Only 40% of patients responded when they were treated after 2 hours. Initial management of status epilepticus consists of:

• Administer any seizure medications
• Support systems to maintain or attain normal breathing, blood pressure, electrolyte balances, body temperature, and heart functions
• Oxygen for patients who may need it
• Attention by medical personnel trained to determine any treatable cause of status epilepticus, such as drug withdrawal, low blood sugar, infection, substance abuse (particularly cocaine), or eclampsia (elevated blood pressure induced by pregnancy)

Medications for Status Epilepticus. One or more of the following medications may be used initially:

• Benzodiazepine. An intravenously (IV) administered or injected benzodiazepine such as lorazepam (Ativan), diazepam (Valium), clonazepam, or midazolam (Versed) is usually used. Lorazepam or clonazepam is now preferred since they have a longer duration of action. Midazolam is the only benzodiazepine available as a muscular injection. Intravenous diazepam is currently the first choice for children with status epilepticus. Rectal administration of benzodiazepines, either diazepam or lorazepam, may also be beneficial. Some evidence suggests that rectal administration of lorazepam is safer and more effective than diazepam in children, but more research is needed.
• Phenytoin or Fosphenytoin. Many doctors use phenytoin or fosphenytoin if seizures are not controlled by a benzodiazepine. These drugs must be prescribed with caution for patients who have liver and blood abnormalities or certain heart arrhythmias. Fosphenytoin works faster, and is safer than phenytoin.
• Phenobarbital. Although effective, barbiturates, such as phenobarbital (Barbita, Luminal), can reduce consciousness, blood pressure, and respiratory rate. They are generally used only when other drugs have failed.