Status epilepticus
The 5-minute rule, benzodiazepine then second-line loading by 20 minutes, refractory and super-refractory status, non-convulsive status and the causes that need their own treatment.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Treat any seizure lasting 5 minutes, or repeated seizures without recovery between them, as status epilepticus.
- Give an adequate benzodiazepine dose early, repeat once, then load a second-line drug by about 20 minutes. Under-dosing and delay are the commonest errors.
- If two lines fail, it's refractory: intubate, anaesthetise and get continuous EEG.
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Sources
- Therapeutic Guidelines: Neurology (status epilepticus)AU/NZTherapeutic Guidelines Limited
- Evidence-based guideline: treatment of convulsive status epilepticus in children and adultsAmerican Epilepsy Society (Epilepsy Currents), 2016
- A definition and classification of status epilepticus: report of the ILAE Task Force on Classification of Status EpilepticusILAE (Epilepsia), 2015
- Guidelines for the evaluation and management of status epilepticusNeurocritical Care Society, 2012
- Guidance for: The acute management of status epilepticus in adult patientsIntensive Care Society (Journal of the Intensive Care Society), 2025
- Randomized trial of three anticonvulsant medications for status epilepticus (ESETT)New England Journal of Medicine, 2019
- Intramuscular versus intravenous therapy for prehospital status epilepticus (RAMPART)New England Journal of Medicine, 2012
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy