Management of status epilepticus.

Significant advances in our understanding of the pathophysiology and evaluation and management of the patient in status epilepticus have markedly decreased associated morbidity and mortality in the last two decades. Any type of seizure can progress to status epilepticus. Identification and management of the cause is of particular importance for those patients for whom initial pharmacologic management fails. This subgroup of individuals tends to have important underlying metabolic, structural, toxic, or infectious causes that must be addressed. Those episodes associated with CNS pathology tend to have a more serious prognosis. Cause aside, appropriate, organized, and timely care will significantly effect outcome. Treatment goals are fourfold: (1) rapid stabilization of the individual, (2) expeditious termination of both clinical and electrical seizure activity, (3) determination and management of life-threatening precipitants, and (4) timely recognition and minimalization of any adverse physiologic sequelae of seizure activity. Benzodiazepines, phenytoin, and phenobarbital remain the most effective first-line and second-line pharmacologic agents. If these agents prove ineffective, appropriately monitored pentobarbital anesthesia appears to be the modality of choice and should be rapidly instituted.