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Management of convulsive status epilepticus in children

Angus Wilfong, MD
Section Editor
Douglas R Nordli, Jr, MD
Deputy Editor
Janet L Wilterdink, MD


Generalized convulsive status epilepticus (SE) is a serious and potentially life-threatening medical emergency that requires prompt intervention. Although the duration of seizures used to define status has varied over time, an accepted definition for the purposes of clinical practice defines SE as a single unremitting seizure lasting longer than five minutes or frequent clinical seizures without an interictal return to the baseline clinical state. This corresponds with the time at which urgent treatment should be initiated. (See "Clinical features and complications of status epilepticus in children", section on 'Definition'.)

The management of SE in children is reviewed here. The definition, pathophysiology, risk factors, and outcome of this disorder are discussed separately. (See "Clinical features and complications of status epilepticus in children".)


Knowledge of the patient's previous response to antiseizure drugs and current medication use may guide approach to management. In deciding initial therapy, the following issues should be considered:

Previous response — If the child has a history of previous status epilepticus (SE), knowing which antiseizure drug was effective in arresting the seizures is helpful. If the child did not respond to phenytoin or fosphenytoin, for example, another drug, such as phenobarbital or valproic acid (VPA), would be preferable.

Missed medication — If the child is on long-term antiseizure drug therapy, it should be determined whether medication has been recently missed or if prescriptions have not been refilled. Antiseizure drug levels obtained upon admission may not be available for many hours and initial treatment decisions may be made without them. If, for example, VPA has provided good seizure control, and the child is known to have missed one or more doses, intravenous VPA, rather than phenytoin, should be considered as initial treatment.

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Literature review current through: Nov 2017. | This topic last updated: Jul 19, 2017.
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