Summary

Status epilepticus (SE) is a neurological emergency defined as continuous seizure activity lasting greater than 5 minutes, or recurrent seizures without recovery between episodes. It carries significant morbidity and mortality if not treated promptly. Management is staged: early SE responds to benzodiazepines; established SE requires antiepileptic drug loading; refractory SE requires anaesthesia and ICU admission.

Key Facts

• Definition: Seizure greater than 5 min or recurrent without recovery
• Incidence: 10-40 per 100,000 per year
• Pathognomonic: Prolonged convulsive activity or non-convulsive (EEG)
• Gold Standard Investigation: Clinical; EEG for non-convulsive
• First-line Treatment: Benzodiazepine (lorazepam/midazolam)
• Prognosis: Mortality 20%; depends on underlying cause

Clinical Pearls

Timing Pearl: Treat after 5 min - don't wait for arbitrary time thresholds.

Benzodiazepine Pearl: IM midazolam as effective as IV lorazepam and faster if no IV access.

Aetiology Pearl: Always search for underlying cause (infection, stroke, drugs, metabolic).

Viva Points

"Status epilepticus: seizure greater than 5 min. First-line: benzo (lorazepam IV or midazolam IM). Second-line: phenytoin or levetiracetam. Refractory: anaesthesia + ICU. Search for cause."

Last Reviewed: 2026-01-01 | MedVellum Editorial Team