Management Algorithm for Status Epilepticus

Management Algorithm for Status Epilepticus - Flowchart Status Epilepticus Status Epilepticus

«Flowchart»

Start

Emergent EEG; assume patient is in NCSE until proven otherwise

Emergent EEG

Patient in clinical status epilepticus (SE)

Patient in clinical status epilepticus (SE) Patient in clinical status epilepticus

End

Patient in confirmed NCSE

Patient in confirmed NCSE Patient in confirmed NCSE

Patient in possible NCSE

Patient in possible NCSE Patient in possible NCSE

Urgent control therapy
Fosphenytoin/phenytoin 20 mg PE/kg IV, or
Valproic acid 20-40 mg/kg IV, or
Levetiracetam 1000-3000 mg IV, or
Phenobarbital 20 mg/kg IV, or
Lacosamide 200-400 mg IV, or
Midazolam 0.2 mg/kg IV, then 0.05-2 mg/kg/hr continuous infusion

Urgent control therapy

Refractory therapy
Midazolam 0.2 mg/kg IV, then 0.05-2 mg/kg/hr continuous infusion, or
Propofol 1-2 mg/kg, then 20 mcg/kg/min continuous infusion, or
Pentobarbital 5-15 mg/kg then 0.5-5 mg/kg/h continuous infusion

Refractory therapy

Seizures stop × 24 h

Observe patient
Prevent SE recurrence
Manage underlying causes

Observe patient Observe patient
Prevent SE recurrence Prevent SE recurrence
Manage underlying causes Manage underlying causes

Wean continuous infusion

Seizures recur

Seizures stop off infusion

Seizures persist

Seizures stop

Critical care/diagnostic evaluation

Emergent initial therapy
Lorazepam 0.1 mg/kg, or
Midazolam 0.2 mg/kg IM/IV, or
Diazepam 0.15 mg/kg

Critical care/diagnostic evaluation

Emergent initial therapy
Lorazepam 0.1 mg/kg, or
Midazolam 0.2 mg/kg IM/IV, or
Diazepam 0.15 mg/kg

Critical care/diagnostic evaluation

Emergent initial therapy
Lorazepam 0.1 mg/kg, or
Midazolam 0.2 mg/kg IM/IV, or
Diazepam 0.15 mg/kg

Emergent initial therapy

Seizures persist

Seizures stop