Status epilepticus
Formal Definition
A life-threatening neurological emergency defined as continuous seizure activity lasting >5 minutes or recurrent seizures without interictal recovery; causes permanent neuronal injury through excitotoxicity; requires immediate pharmacologic termination (abortive therapy) using benzodiazepines as first-line, followed by escalating second-line agents and consideration of anesthetic-level therapy for refractory cases.
How It's Used on the Ward
Status or status epilepticus or patient is seizing and won't stop — a seizure that has been going on for more than 5 minutes; medical emergency that causes brain damage with each passing minute.
Example
"Patient found seizing, generalized tonic-clonic movements for 8 minutes and counting. BZ 10mg IV lorazepam pushed. If still seizing after 2 minutes: second dose. If still seizing after 4 more minutes: fosphenytoin 20mg/kg IV. If still seizing: phenobarbital 15mg/kg IV. If still seizing after that: call ICU for intubation and midazolam or propofol drip."
Clinical Context
Time is brain: >5 minutes of continuous seizure = status epilepticus. Staged protocol: Stage 1 (0-5min) — benzodiazepines (lorazepam 0.1mg/kg IV, diazepam 10mg PR, midazolam 10mg IM/IN). Stage 2 (5-20min) — second-line (fosphenytoin 20mg/kg, valproic acid 30mg/kg, levetiracetam 60mg/kg). Stage 3 (>20min) — anesthetic agents (midazolam, propofol, pentobarbital) with EEG monitoring for burst suppression. Refractory status: requires ICU and continuous EEG. Causes: non-compliance, alcohol withdrawal, CNS infection, metabolic, tumor — workup simultaneously with abortive therapy.