Medical Management Considerations
Status epilepticus is defined as more than 30 minutes of (1) continuous seizure activity or (2) two or more sequential seizures with out full recovery of consciouslness between seizures. Seizures may be convulsive or non-convulsive. The longer the seizure continues, the greater the likelihood of an adverse outcome such as neurologic damage or death. (Return to the index to view a document on the management of epilepsy.)
Incidence : 18-50 cases per 100,000 persons/year Approx. 260,000 new/recurrent cases of status epilepticus per year.
Epilepsy affects 1:200 individuals in the general population and 1:4 individuals with mental retardation. It is estimated that up to 20% of people with epilepsy experience status epilepticus. About 75% of patients who experience status epilepticus are under the age of 5. Status epilepticus is less frequent in individuals whose epilepsy is well-controlled.
Note: These considerations are in addition to the normal medical care provided to an individual without status epilepticus.
Note: Emergency services should be contacted if there is any concern for the well-being of the patient. Because no one can accurately predict whether a seizure will last twenty to thirty minutes or more (which is a requirement for the diagnosis of status epilepticus), and because appropriate emergency care may not be accessible due to distance or time, caregivers should be prepared to administer rectal diazepam (Diastat). Diastat is appropriate for epileptic patients ages 2 and over who have a seizure lasting longer than five minutes.
0 to 5 minutes
6 to 10 minutes
Note: The noted times may not be applicable in the emergency room setting. Many tests and procedures may occur concurrently, such as IV access, medication administration, etc.
31 to 45 minutes
After seizure stops
(Return to the index to view a general epilepsy document)
Cruse, Robert P. (2005) Treatment of Status Epilepticus. Cleveland Clinic Journal of Medicine, 56(2), 254-259.
Kaplan, P.W. (2005). The Clinical Features, Diagnosis and Prognosis of Nonculvulsive Status Epilepticus. The Neurologist, 11(6), 348-361.
Walker, M.C. (1998). The Epidemiology and Management of Status Epilepticus. Current Opinion in Neurology 11(2), 149-154.
Lowenstein, D.H. (2003). Treatment Options for Status Epilepticus. Current Opinion in Pharmacology, 3(1), 6-11.
Sabo-Graham, R., Seay, A.R. (1998). Management of Status Epilepticus in Children. Pediatrics in Review, 19(9), 306-309
Treatment of Convulsive Status Epilepticus: Recommendations of the Epilepsy Foundation of America’s Working Group on Status Epilepticus.(1993) Journal of the American Medical Association, 270(7), 854-859.
Appleton, R. et al. (2000). The Treatment of Convulsive Status Epilepticus in Children: The Status Epilepticus Working Party. Archives of Disease in Childhood, 83(5), 415-419..
Gibson, J.R. Jr. (1999). Status Epilepticus. In M.R. Dambro(Ed.) Griffith’s 5 Minute Clinical Consult. (pp. 1006-1007) Baltimore: Lippincott Williams & Wilkins.
Gordon, A. et al. (2005). AREA OF FOCUS VI: Epilepsy and Status Epilepticus. Retrieved on March 2, 2006 from http://www.ninds.nih.gov/about_ninds/plans/disparities.htm#epilepsy
Huff, S. (2005). Status Epilepticus. eMedicine. Retrieved March 2, 2006, from http://www.emedicine.com/EMERG/topic554.htm
Kastner, T. (1998). Group Home Staff Instructions for the Use of Diastat (Rectal Valium) To Control Seizures. Unpublished document.
Kelley, R.E. (1997). Status Epilepticus: Diagnosis and Management. Louisiana State University Medical Center website. Retrieved on March 2, 2006 from http://lib-sh.lsuhsc.edu/fammed/intern/statepil.html
Prasad, A. et al. (2001) Propofol and Midazolam in the Treatment of Refractory Status Epilepticus. Epilepsia, 42(3), 380-386.
Rossetti, A. et al. (2004). Propofol Treatment of Refractory Status Epilepticus: A Study of 31 Episodes. Epilepsia, 45(7), 757-763.
Sinclair, D. (1997). Status Epilepticus. University of Alberta Department of Pediatrics web site. Retrieved on March 2, 2006 from http://www.ualberta.ca/~pediatri/clinical/statepi.htm
Smith Consultant Group and McGowan Consultants. (1998). Epilepsy. In M. Ligon Snyder,(Ed.) Health and Wellness Reference Guide. (pp.197-214).Neri Productions, State of Tennessee Commission on Compliance.
Young, G.M. (1998). Pediatrics Status Epilepticus, eMedicine, Retrieved on March 2, 2006 from http://www.emedicine.com/emerg/topic404.htm
American Epilepsy Society,
Bowman Gray School of Medicine Epilepsy Information Service, 800-642-0500
California Department of Developmental Services, 916-654-1690,
California Regional Centers, 915-654-1958,
Epilepsy Foundation of America, 800-332-1000,
International Bureau for Epilepsy
Epilepsy Society of San Diego County, 619-296-0161
Exceptional Parent Magazine, 800-247-8080,
March of Dimes Birth Defects Foundation, 914-428-7100,
New York Hospital Epilepsy Center,
Theodore A. Kastner, M.D., M.S.
Felice Weber Parisi, M.D., M.P.H.
Mary Ann Lewis, Dr.P.H., R.N., F.A.A.N.
Jaime D. Mejlszenkier, M.D., F.A.A.N
Terrance D. Wardinsky, M.D.
Funded by a grant from the California Department of Developmental Services
For more information, contact:
Center for Health Improvement
1330 21st Street, Suite 100
This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services and the Center for Health Improvement.