status epilepticus


Seizure lasting greater than 20 minutes or multiple seizures from which the patient does not regain consciousness.




  1. Failing to take medication
  2. Sepsis
  3. Meningitis/encephalitis
  4. Trauma
  5. Toxic/metabolic encephalopathies
  6. Fever

Clinical features

Seizures may be of the convulsive (usually generalized tonic-clonic) type or non-convulsive type (e.g. abscence or partial complex). Therefore, the patient may simply appear confused or dazed. Seizures lasting longer than 20 minutes begin to produce irreversible neurologic damage or death.



  1. electrolytes, Ca++, Mg++
  2. glucose
  3. blood culture
  4. anticonvulsant level


An LP may be necessary to rule out meningitis/encephalitis if clinical symptoms exist.

CT scan

A CT scan may be important to rule out intra-cranial hemorrhage or stroke.



The airway must be cleared with suction and a plastic airway inserted. The patient should be placed on their side to prevent aspiration. Also be sure to loosen tight clothing and place the patient on a soft surface. The patient should not be restrained. Objects such as tongue depressors should not be placed in the mouth.


Oxygen by mask must be given to prevent hypoxia and avoid neurologic sequelae.


All the medications require IV access for rapid onset of action.


Benzodiazepines will cause respiratory depression especially in children. Do not exceed the maximum dosesand avoid if barbiturates have been given.

A rule of thumb is use a maximum of 1 mg per year of age to a maximum of 10 mg. May be repeated once following phenytoin if seizures persist.


If seizure continues, may follow with phenytoin. Monitor with close ECG and BP monitoring. Cannot be given IM.

May be repeated once to maximum of 30-40 mg/kg total dose.


If seizures persist, phenobarbital may be given. Phenobarbital is also an alternate choice, but respiratory depression especially following benzodiazepines is significant. Be prepared to ventilate.

This dose can be repeated to a maximum of 30-40 mg/kg total dose. If no venous access available the same dose may be given IM, but has a slower onset of action.

General anaesthetic

If seizures still persist despite the above treatment, then the patient is intubated, ventilated, paralyzed, and general anesthetic given.

Dr. Sinclair
Pediatric Neurology
Department of Pediatrics
University of Alberta
Revised: July 08, 1997