Status epilepticus is defined as continuous seizure activity lasting >30 min or more than two discrete seizures, between which the patient does not recover consciousness. About 50% of patients have known epilepsy, and status may be secondary to poor drug compliance with anticonvulsant therapy, a change in anticonvulsant therapy or alcohol withdrawal. Other causes of status epilepticus are listed below.

History of epilepsy

1. • Poor compliance

2. • Recent change in medication

3. • Drug interactions

4. • Withdrawal of the effects of alcohol

5. • Pseudostatus

No history of epilepsy

1. • Intracranial tumour/abscess

2. • Intracranial haemorrhage

3. • Stroke

4. • Head injury or surgery

5. • Infection – meningitis, encephalitis

6. • Febrile convulsions in children

7. • Metabolic abnormalities – hypoglycaemia, hypocalcaemia, hyponatraemia, hypomagnesaemia, hypoxia

8. • Drug toxicity

9. • Drug or alcohol withdrawal

10. • Use of antagonists in mixed drug overdoses

Status epilepticus is divided into four stages. There is usually a preceding period of increasing seizures – the premonitory stage, which can be treated with a benzodiazepine such as clobazam 10 mg. Early treatment at this stage may prevent the development of the next stage. Early status epilepticus can usually be terminated by an IV bolus of lorazepam 4 mg, repeated after 10 min if no response. If there is no response to benzodiazepine therapy after 30 min, established status epilepticus has developed and either phenobarbital, phenytoin or fosphenytoin should be given.