Status epilepticus

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Target exams

Red flags

• A convulsion lasting longer than five minutes is status epilepticus and needs drug treatment, not observation
• Delayed or insufficient early benzodiazepine treatment lets the seizure run into the zone where drugs work less well
• Benzodiazepine efficacy falls steeply with time, so the first dose must be full and on time
• After rapid sequence intubation the patient may be paralysed but still seizing, so continuous EEG monitoring is mandatory
• Ongoing convulsion beyond 30 minutes carries a rising risk of neuronal injury and must trigger anaesthetic escalation
• Hypoglycaemia, hyponatraemia, hypocalcaemia, and central infection are reversible causes that must be sought and treated in parallel
• Refractory status epilepticus in a young infant demands an urgent broad workup for central infection and inborn errors of metabolism

Life stages

Care settings

Clinical exam formats

Board mappings

• Defines a convulsion lasting over five minutes as status epilepticus and states that early full-dose benzodiazepine is first-line
• States the APLS stepwise pathway of benzodiazepine first, then levetiracetam or fosphenytoin, then rapid sequence intubation and infusion
• Identifies hypoglycaemia, electrolyte disturbance, and central infection as reversible causes to seek and treat in parallel
• Applies the ILAE operational definition with the t1 and t2 time points to convulsive and non-convulsive status epilepticus
• Explains the time-dependent pharmacodynamic shift of GABA-A receptor internalisation and glutamate receptor recruitment that erodes benzodiazepine efficacy
• Critically appraises the ConSEPT, EcLiPSE, and ESETT trials and justifies the choice of second-line agent, and manages refractory status with anaesthetic infusion and continuous EEG
• ILAE definition and the t1 of five minutes and t2 of thirty minutes for convulsive status epilepticus
• First-line benzodiazepine doses and the second-line levetiracetam and fosphenytoin doses with maxima
• The refractory pathway with rapid sequence intubation and the mandatory role of continuous EEG after paralysis
• Runs the stepwise resuscitation of a child in convulsive status epilepticus within the time-critical window
• Selects and doses the second-line agent and escalates to anaesthetic infusion when the seizure persists
• Counsels the family on the cause search, the intensive care course, and the neurodevelopmental follow-up
• Level 1: Recognition that a convulsion over five minutes is status epilepticus requiring early drug treatment
• Level 2: Application of the stepwise benzodiazepine then second-line then anaesthetic pathway with reversible-cause screening
• Level 3: Coordination of refractory management, continuous EEG interpretation, and the aetiological and neurodevelopmental follow-up
• ILAE operational definition and the early, established, and refractory phases
• Pharmacodynamic basis for declining benzodiazepine efficacy and the rationale for early full dosing
• Evidence from ConSEPT, EcLiPSE, and ESETT on second-line levetiracetam versus fosphenytoin and valproate
• Structured stepwise assessment and drug dosing of a convulsing child to weight
• Recognition of non-convulsive status and the need for continuous EEG after paralysis
• Communication of the cause search, the intensive care plan, and the prognosis to the family
• Status epilepticus as a five-minute convulsion requiring early benzodiazepine and stepwise escalation
• Second-line levetiracetam or fosphenytoin dosing and the trial evidence behind the choice
• Refractory management with anaesthetic infusion and continuous EEG monitoring
• Recognition of convulsive status epilepticus and the early administration of an adequate benzodiazepine dose
• Stepwise escalation to second-line therapy and then to anaesthetic infusion for refractory seizures
• Screening for reversible causes and arranging the neurodevelopmental follow-up
• Canadian stepwise pathway for paediatric convulsive status epilepticus with benzodiazepine first-line
• Second-line levetiracetam or fosphenytoin and the trial evidence from ESETT and the paediatric trials
• Refractory pathway with rapid sequence intubation, anaesthetic infusion, and continuous EEG