🧠 Convulsive Status Epilepticus Staged Management
UseStaged emergency management of convulsive status epilepticus.
SourceKapur J, et al. ESETT trial. N Engl J Med 2019 / Neurocritical Care Society & ILAE status epileptic…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Treat as status epilepticus once a convulsion exceeds 5 minutes; earlier control gives a better prognosis.
When to use
Staged emergency management of convulsive status epilepticus.
How it works
5–20 min (first-line): full-dose benzodiazepine (lorazepam, or diazepam; IM midazolam if no IV). 20–40 min (second-line): IV valproate, levetiracetam, or (fos)phenytoin PE — similar efficacy in the ESETT trial (study finding). > 40 min / two lines failed (refractory): continuous anesthetic infusion + intubation + cEEG in ICU.
Key points
- Treat as status epilepticus once a convulsion exceeds 5 minutes; earlier control gives a better prognosis.
- The ESETT trial showed similar efficacy for the three second-line agents (study finding) — choose by availability and patient factors.
- Throughout, address ABC, monitor cardiac/oxygenation, check glucose (give dextrose + thiamine if low) and find the trigger.
- Refractory status needs continuous IV anesthetic (midazolam/propofol/thiopental) with continuous EEG to target seizure control or burst-suppression.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Current stage | 20–40 min (second-line) |
|---|---|
| IV access | Yes |
→Current actionSecond-line: IV antiseizure medication
- Drug：IV antiseizure medication (choose one, full loading dose): sodium valproate, or levetiracetam, or (fos)phenytoin PE; the ESETT trial showed similar efficacy for all three (study finding)
- Whole-course：Simultaneously address ABC (airway/breathing/circulation), cardiac/oximetry monitoring, check glucose (give 50% dextrose + thiamine if hypoglycemic), investigate and treat triggers (drug withdrawal, infection, electrolytes, toxins, etc.)
- Timeline：A convulsion > 5 min is managed as SE; 5–20 min first-line, 20–40 min second-line, > 40 min or two lines failed is refractory; earlier control gives a better prognosis
| Current stage | 5–20 min (first-line) |
|---|---|
| IV access | Yes |
→Current actionFirst-line: benzodiazepine
- Drug：IV benzodiazepine: lorazepam (single dose), or diazepam IV push; may repeat once if not stopped in 5 minutes
- Whole-course：Simultaneously address ABC (airway/breathing/circulation), cardiac/oximetry monitoring, check glucose (give 50% dextrose + thiamine if hypoglycemic), investigate and treat triggers (drug withdrawal, infection, electrolytes, toxins, etc.)
- Timeline：A convulsion > 5 min is managed as SE; 5–20 min first-line, 20–40 min second-line, > 40 min or two lines failed is refractory; earlier control gives a better prognosis
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Convulsive Status Epilepticus Staged Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Convulsive Status Epilepticus Staged Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Convulsive Status Epilepticus Staged Management calculated in practice? Can you show a worked example?
- Inputs: Current stage 20–40 min (second-line), IV access Yes → Result: Current action Second-line: IV antiseizure medication（Drug: IV antiseizure medication (choose one, full loading dose): sodium valproate, or levetiracetam, or (fos)phenytoin PE; the ESETT trial showed similar efficacy for all three (study finding), Whole-course: Simultaneously address ABC (airway/breathing/circulation), cardiac/oximetry monitoring, check glucose (give 50% dextrose + thiamine if hypoglycemic), investigate and treat triggers (drug withdrawal, infection, electrolytes, toxins, etc.), Timeline: A convulsion > 5 min is managed as SE; 5–20 min first-line, 20–40 min second-line, > 40 min or two lines failed is refractory; earlier control gives a better prognosis） Inputs: Current stage 5–20 min (first-line), IV access Yes → Result: Current action First-line: benzodiazepine（Drug: IV benzodiazepine: lorazepam (single dose), or diazepam IV push; may repeat once if not stopped in 5 minutes, Whole-course: Simultaneously address ABC (airway/breathing/circulation), cardiac/oximetry monitoring, check glucose (give 50% dextrose + thiamine if hypoglycemic), investigate and treat triggers (drug withdrawal, infection, electrolytes, toxins, etc.), Timeline: A convulsion > 5 min is managed as SE; 5–20 min first-line, 20–40 min second-line, > 40 min or two lines failed is refractory; earlier control gives a better prognosis）