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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