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Chapter: Modern Pharmacology with Clinical Applications: Antiepileptic Drugs

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Treatment of Status Epilepticus

Status epilepticus is a continuous seizure state that can prove fatal unless the convulsions are terminated.

TREATMENT OF STATUS EPILEPTICUS

Status epilepticus is a continuous seizure state that can prove fatal unless the convulsions are terminated. It is a leading cause of death in epileptic patients and must be considered a medical emergency.The choice of drug may not be as important as establishing and correcting the cause of the seizures, maintaining vital functions, and beginning drug treatment as soon as possible. Virtually any general CNS depressant, including general anesthet-ics, can be used to terminate the seizure state. The phar-macological treatment of choice at present consists of in-travenous infusion of either diazepam or lorazepam (the only benzodiazepines available in the United States for parenteral administration) or fosphenytoin.

Fosphenytoin (Cerebyx) is a prodrug that is highly soluble in intravenous solutions without solubilizing agents and is supplied in vials for intravenous use. Fosphenytoin is converted to phenytoin following par-enteral administration. It is very effective in terminating seizures and will stop most status epilepticus episodes and provide long-term control without any decreased level of consciousness. All of these drugs should be ad-ministered slowly to avoid respiratory depression and apnea.

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