Template:Seizure actively seizing management

Protect patient from injury
- If possible place patient in left lateral position to reduce risk of aspiration
- Do not place bite block
- Ensure clear airway after seizure stops
Benzodiazepine
- Initial therapy of choice^[1]
  - Midazolam IM 10mg (>40kg), 5mg (13-40kg), or 0.2mg/kg^[2]
  - Lorazepam IV 2mg or 0.1mg/kg
  - Diazepam IV 0.15-0.2mg/kg (up to 10mg)
- Alternatives
  - Diazepam PR 0.2-0.5mg/kg (up to 20mg)
  - Midazolam PN or Buccal
Secondary medications
- Fosphenytoin 20-30mg/kg/PE at 150mg/min
  - Contraindicated in pts w/ 2nd or 3rd degree AV block
  - May be given IM
- Valproic acid IV 20-40mg/kg at 5mg/kg/min
- Levetiracetam IV 60mg/kg, max 4500mg/dose
- Phenobarbital IV 20mg/kg at 50-75mg/min (be prepared to intubate)
Refractory medications
- Propofol 2-5mg/kg, then infusion of 2-10mg/kg/hr OR
- Midazolam 0.2mg/kg then inusion of 0.05-2mg/kg/hr OR
- Ketamine 1.5mg/kg then 0.01-0.05mg/kg/hr
- Anesthesia consult for inhaled anesthetics in OR for refractory status epilepticus^[3]
Consider
- Secondary causes of seizure (e.g. hyponatremia, hypoglycemia, [[INH Toxicity, ecclampsia)
- EEG to rule-out nonconvulsive status
- Prophylactic intubation

↑ Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16(1):48-61.
↑ McMullan J, Sasson C, Pancioli A, Silbergleit R: Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med 2010; 17:575-582
↑ Mirsattari SM et al. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004 Aug;61(8):1254-9.