Status epilepticus (SE) is the most common status epilepticus in neurology. One of the severe cases, rapid termination of status epilepticus seizures is the key to treatment. The Chinese Anti-Epileptic Association Drug Treatment Professional Committee organized multidisciplinary experts to jointly formulate the “Expert Consensus on Termination of Status Epilepsy Attacks”, in order to provide an operable method for quickly terminating status epilepticus seizures, thereby improving the prognosis of patients. Regarding the commonly used treatment methods and dosage of SE, the consensus mainly involves the following contents.
1Common treatments Choice of Approach
➤The following order of treatment is recommended :
diazepam or lorazepam→clonazepam→phenobarbital, valproic acid, levetiracetam→midazole Leon→propofol→ketamine→combination medication→ketogenic diet→mild hypothermia→electroconvulsive therapy.
2Common Medications Dosage
➤diazepam injection: Consider the first option for IV administration of SE in adults If it is ineffective, it can be injected again after 5 minutes; if it is effective (the seizures stop), 80-100 mg of diazepam is added to 5% glucose solution by intravenous drip (12 h); if the drug is effective, but the recurrence is maintained during maintenance, 10-20 mg of diazepam can be injected again; if the treatment is ineffective, the drug should be discontinued and other recommended drugs should be used.
➤Clonazepam: Adult SE A slow bolus injection of 1-2 mg intravenously can be considered. If it is ineffective within 10-15 minutes, it can be repeated once. If it is still ineffective, the drug should be discontinued and other recommended drugs should be used. For those who are effective after intravenous bolus injection, 1-2 mg intravenous bolus can be used to maintain it once every 12 hours, and discontinuation can be considered for 1-2 days after the seizure stops.
➤Valproic acid: Adult SE patients Consider intravenous bolus injection of 20-40 mg/(kg.d), double the first dose. First, inject 20-40 mg/kg intravenously at 3-6 mg/(kg.min), then inject the same dose intravenously, and then inject 20-40 mg/(kg.d) intravenously the next day. If the treatment is effective for 2 to 3 days, after the patient’s seizures stop and his consciousness recovers, oral therapy (sequential therapy) can be changed to control the long-term seizures of epilepsy; if it is ineffective, stop it and choose other recommended drugs.
➤phenobarbital: Adult SE Patients can consider to inject 10-15 mg/kg slowly intravenously (at a rate of 50-100 mg/min) at first, and after effective, use 100-200 mg/time, intramuscular injection twice a day to maintain for 1-2 d, if ineffective Stop the drug and choose another recommended drug.
➤Levetiracetam: Adults SE patients can consider 1000-1500 mg intravenous bolus injection at a rate of 2-5 mg/(kg.min). If the seizures do not stop or EEG shows persistent epileptiform discharges, RSE should be considered, and additional Dosage. After effective, continuous infusion of 0.05-2 mg/(kg.h), loading dose of 1500-3000 mg/d, maximum dose of 4500 mg, if invalid, discontinue the drug and choose other recommended drugs. Combination medication is mainly used in combination with benzodiazepines for the treatment of super RSE. When used in combination with benzodiazepines, the recommended dose of levetiracetam is 2500 mg by slow intravenous injection (> 5 min). Add levetiracetam on the basis, or use benzodiazepines at the same time.
➤Midazolam: Adult SE Intravenous administration of 0.1-0.2 mg/kg slowly (2-4 mg/min) can be considered. If it is ineffective, it can be repeated once. If it is still ineffective, the drug should be discontinued and other recommended drugs should be used. If it is effective, it can be injected intravenously at 0.1-0.3 mg/(kg.h) for 12 hours. Recurrence in maintenance can be repeated 1 bolus.
➤Propofol: Adult SE Intravenous medication can be considered as a slow intravenous injection of 1-2 mg/kg. If it is ineffective, it can be repeated once. If it is still ineffective, the drug should be discontinued and other recommended drugs should be used. If it is effective, it can be injected intravenously at 1~4 mg/(kg.h) for 10~12 hours. 1 additional bolus may be given for recurrence during maintenance.
➤Ketamine: Consideration in adults with SE The loading dose is 1-3 mg/kg (maximum 4.5 mg/kg), administered as an intravenous bolus at a maximum rate of 100 μg/(kg·min). When ketamine is administered intravenously, it can be administered either as an IV bolus followed by a continuous IV infusion, or by a continuous IV infusion only.formula for treatment. The combination of ketamine is mainly selected after the first-line or second-line drugs such as diazepam, lorazepam, and phenytoin are ineffective.
➤Combination
< span>Clinical application: At present, the combined application of anti-SE drugs mainly involves levetiracetam, ketamine, midazolam, phenytoin, barbiturates, stiripentol and immunomodulatory drugs, etc., but ketamine is more successful , midazolam, valproic acid, levetiracetam.
The above content is excerpted from: Chinese Anti-epilepsy Association Drug Therapy Professional Committee. The PLA Medical Journal, Expert Consensus on Termination of Status Epilepsy. 2022,47(7):639-646.
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