Neurocritical Care

Laboratory tests often show electrolyte abnormalities (particularly sodium, magnesium, and

phosphorus), and serum lactate may be elevated in the acute period after seizure activity.

Continuous monitoring is preferred in patients with status epilepticus to capture intermittent or

fluctuating seizure patterns (Neurocrit Care 2012;17:3-23).

Typical recommended duration is at least 48 hours, and monitoring should be initiated as soon as

possible after suggestion or diagnosis of seizure.

Etiology (see Table 5).

Cause of Status Epilepticus

Approximate % of Patients

Epilepsy

33–55

Miscellaneous

12–24

Stroke

14–22

Anticonvulsant nonadherence

Drug withdrawal

10–14

Brain tumor

Metabolic

TBI

Drug toxicity

CNS infection

CNS = central nervous system; TBI = traumatic brain injury.

Mortality rate ranges from 9% (primarily in patients with preexisting epilepsy/anticonvulsant

medication nonadherence) to 30% (in patients with a concomitant pathology such as TBI or stroke).

Mortality in nonconvulsive status epilepticus is about double compared with overt seizures.

Older adults have a higher mortality rate.

epilepticus ultimately have a resultant neurologic deficit.

for first- and second-line therapies are for children and adults

First-line therapy (emergent)

Benzodiazepine therapy preferred; appropriate dosing is essential – Do NOT underdose first-line

therapy

Lorazepam 0.1 mg/kg intravenously (maximum 4 mg/dose) OR

Midazolam 5–10 mg (or 0.2 mg/kg, maximum dose 10 mg) intramuscularly (preferred for patients

with no intravenous access) OR

maximum 20 mg/dose) – Not recommended as first-line therapy for hospitalized patients because

of short duration of seizure control