Status epilepticus

Premonitory stage (pre-hospital)

Diazepam 10−20 mg given rectally, repeated once 15 minutes later if status continues to threaten, or midazolam 10 mg given buccally.

If seizures continue, treat as below.

Early status

Lorazepam (intravenous) 0.1 mg/kg (usually a 4 mg bolus, repeated once after 10−20 minutes; rate not critical).

Give usual AED medication if already on treatment.

For sustained control or if seizures continue, treat as below.

Established status

Phenytoin infusion at a dose of 15–18 mg/kg at a rate of 50 mg/minute or fosphenytoin infusion at a dose of 15−20 mg phenytoin equivalents (PE)/kg at a rate of 50–100 mg PE/minute and/or phenobarbital bolus of 10–15 mg/kg at a rate of 100 mg/minute.

Refractory status^a

General anaesthesia, with one of (under specialist advice)

^a In the above scheme, the refractory stage (general anaesthesia) is reached 60/90 minutes after the initial therapy.