Status epilepticus: Beyond guidelines

Status epilepticus is the most common neurological emergency in paediatric practice. If convulsive status epilepticus is prolonged (i.e. greater than 30 min) then there is a loss of cerebral autoregulation that results in cerebral oedema and ischaemic injury to the brain. There may be permanent neurological sequelae. The aims of treatment are to terminate the seizure as rapidly as possible and to identify and treat any underlying causes. Treatment guidelines for established convulsive status epilepticus have recently been developed by the Status Epilepticus Working Party, have been endorsed by the National Institute of Clinical Excellence (NICE) and are recommended here. The treatment of refractory convulsive status epilepticus and the less well recognised non-convulsive status epilepticus is problematic but management options are discussed in this article.