MGH Status Epilepticus Treatment Protocol

1st line (seizures ongoing for 5-10 mins): 

 - Lorazepam 4mg IV (push over 2mins), If szs not controlled within 5mins, repeat 4mg IV x 1

 - If no IV access: Diazepam 20mg rectally (using IV sol’n) or, Midazolam 10mg intranasal/buccal/IM (using IV sol’n).

2nd line (10-30 mins) - If seizures persist - Choose from the following (may be used in combination):

  1) Valproic acid 40mg/kg IV (max rate 6mg/kg/min)

  2) Levetiracetam 20mg/kg IV (max rate 100mg/min)

  3) Phenobarbital 20mg/kg IV (max rate 50-75mg/min)

  4) Fosphenytoin 20mg PE/kg IV (max rate 150mg PE/min) or, Phenytoin 20 mg/kg IV (max rate 25-50mg/min)  If no effect, can give additional dose: Fosphenytoin 10mg PE/kg IV or Phenytoin 10 mg/kg IV

  5) Lacosamide 400mg IV over 5 min (need EKG pre/post)

3rd line (30 - 60 mins) REFRACTORY STATUS EPILEPTICUS:

1) Midazolam (good choice if BP unstable) - Load 0.2mg/kg IV, Repeat q5mins until szs stop (max load 2mg/kg), Maint. infusion 0.1-- 2 mg/kg/hr

2) Propofol - Load 2mg/kg IV, Repeat q5mins until szs stop (max load 10mg/kg), Maint. infusion 1--10mg/kg/hr (< 5 if tx > 48hrs)



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