What is the first-line benzodiazepine dose for SE?

Lorazepam 0.1 mg/kg IV (max 4 mg/dose, may repeat once); diazepam 0.2 mg/kg IV or 0.5 mg/kg rectal; midazolam 0.2 mg/kg IM/buccal/intranasal (fastest non-IV route); onset 2-5 min IV; repeat if seizure continuing at 5 min.

What is the ESETT trial AED recommendation for established SE?

ESETT trial (2019): levetiracetam 60 mg/kg (max 4.5g), fosphenytoin 20 mg PE/kg (max 1500 mg PE), and valproate 40 mg/kg (max 3g) have equivalent efficacy (~50% SE termination rate); all equivalent, choice based on AED history and clinical factors.

When is intubation required for refractory SE?

Refractory SE (>60 min or failed 2 AEDs): requires continuous EEG monitoring, ICU admission, and often intubation for IV propofol (1-2 mg/kg bolus, then 20-200 mcg/kg/min) or midazolam infusion (0.05-2 mg/kg/h); titrate to EEG burst suppression or seizure control.

How is non-convulsive SE diagnosed?

NCSE: clinical suspicion in unresponsive patient after convulsive SE, or unexplained altered consciousness; continuous EEG required; Salzburg criteria for NCSE: epileptiform activity >2.5 Hz, or ≤0.5 Hz with subtle clinical features, or with clinical/EEG response to AED.

What is the Treiman et al. time-based protocol for SE?

Stage 1 (0-30 min): IV benzodiazepine; Stage 2 (30-60 min): IV AED (fosphenytoin/LEV/VPA); Stage 3 (>60 min): refractory SE - anesthetic doses (propofol, midazolam, phenobarbitone, thiopentone); Stage 4 (>24h): super-refractory SE - immunotherapy, diet, surgery considered.

Status Epilepticus Treatment Protocol and AED Dosing

Calculates time-based status epilepticus treatment algorithm: benzodiazepine phase (lorazepam/diazepam), second-line AED (levetiracetam/valproate/lacosamide), and refractory SE (propofol/midazolam/thiopentone) dosing by weight.

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Frequently Asked Questions

What is the first-line benzodiazepine dose for SE?

What is the ESETT trial AED recommendation for established SE?

When is intubation required for refractory SE?

How is non-convulsive SE diagnosed?

What is the Treiman et al. time-based protocol for SE?