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Convulsive status epilepticus in adults: Treatment and prognosis

Frank W Drislane, MD
Section Editor
Timothy A Pedley, MD
Deputy Editor
April F Eichler, MD, MPH


Status epilepticus is a relatively common medical and neurologic emergency that requires prompt evaluation and treatment. Status epilepticus manifests as many different syndromes, each defined by distinctive clinical features and EEG findings. Causes, prognoses, and treatments differ, and optimal evaluation and treatment requires an understanding of both the type of status epilepticus and the underlying cause. Some forms of status epilepticus have an excellent prognosis, whereas others are associated with major morbidity or even mortality.

The definition, classification, clinical features, and diagnosis of convulsive status epilepticus in adults are reviewed separately. (See "Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis".)

Treatment and prognosis of convulsive status epilepticus is discussed below. Nonconvulsive status epilepticus and the diagnosis and management of status epilepticus in children are discussed separately. (See "Nonconvulsive status epilepticus" and "Clinical features and complications of status epilepticus in children" and "Management of convulsive status epilepticus in children".)


All patients with generalized convulsive status epilepticus (GCSE) require rapid evaluation and treatment. GCSE is operationally defined as ≥5 minutes of continuous seizure activity, or more than one seizure without recovery in between [1,2]. (See "Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis", section on 'Definition'.)

Many possible pharmacologic approaches have been developed empirically, but there are few controlled trials comparing different regimens [3-6]. The approach outlined below is generally consistent with consensus-based guidelines published by the Neurocritical Care Society [1].


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