Status epilepticus is a serious and potentially life-threatening medical emergency that requires prompt intervention. In 2016, the American Epilepsy Society released evidence-based guidelines and a treatment algorithm for status epilepticus in adult and pediatric patients. The treatment algorithm consisted of four phases laid out in a timeline format: stabilization, initial therapy, second therapy, and third therapy. Following stabilization, the initial therapy phase focuses on benzodiazepines as the treatment of choice. For the remaining phases of therapy and treatment of refractory seizures, there is a paucity of evidence to guide the optimal approach. Reasonable agents to consider following first-line agents include fosphenytoin, levetiracetam, valproic acid, or phenobarbital. For third-line treatment, continuous sedative infusions of pentobarbital, midazolam or propofol can be considered. Although not included in the guideline, ketamine has emerged as another potential option for the treatment of refractory status epilepticus. Further studies are necessary to evaluate the efficacy and safety of these agents and determine their place in therapy.
Pediatr Pharm. 2018;24(2) © 2018 University of Virginia