EM · Status epilepticus
Status epilepticus
Also known as Convulsive status epilepticus · Non-convulsive status epilepticus · Refractory status epilepticus
Status epilepticus — a continuous seizure lasting over 5 minutes, or recurrent seizures without recovery of consciousness, stratified into early (0-5 min), established (5-30 min) and refractory (over 30 min) phases, managed up a pharmacological ladder of benzodiazepine (lorazepam 4 mg IV or midazolam 10 mg IM), then a second-line anti-seizure medication (fosphenytoin 20 mg PE/kg, levetiracetam 60 mg/kg, valproate 30 mg/kg), then anaesthetic infusion (propofol, midazolam, thiopentone) for refractory disease. The causes (non-compliance, alcohol withdrawal, intracranial pathology, metabolic), the airway (recovery position, oxygen, intubation for refractory), and the complications (hypoxia, aspiration, rhabdomyolysis, hyperthermia). ACEM-primary, globally tagged.
On this page & tools
Your progress
Saved locally on this device.
Target exams
Red flags
Related topics
Meet the patient
A 52-year-old man with known epilepsy is wheeled in still seizing, twelve minutes in. He ran out of his levetiracetam a week ago. IV access is in, capillary glucose is 6.2 mmol/L, oxygen is on, and the clock is already running against him.[1]
Two questions decide his next half-hour: has the seizure passed five minutes? (it has — he is now "established status", so the benzodiazepine alone is not the plan) and what is the cause? (non-adherence here, but always exclude hypoglycaemia, infection, and an intracranial lesion). Hold those two questions and the ladder below slots into place.[1]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Emergency Medicine fellowship atlas.
References6Show ledgerHide ledger
- [1]Kapur J, Elm J, Chamberlain JM, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus N Engl J Med, 2019.PMID 31774955
- [2]Chamberlain JM, Kapur J, Shinnar S, et al. Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial Lancet, 2020.PMID 32203691
- [3]Vossler DG First Seizures, Acute Repetitive Seizures, and Status Epilepticus Continuum (Minneap Minn), 2025.PMID 39899098
- [4]Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus N Engl J Med, 2012.PMID 22335736
- [5]Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group N Engl J Med, 1998.PMID 9738086
- [6]Lyttle MD, Rainford NEA, Gamble C, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial Lancet, 2019.PMID 31005385