UMEM Educational Pearls

A new guideline for convulsive status epilepticus in adults AND children was recently published. [1] An insightful commentary was published alongside it (both are open access). [2] The proposed algorithm is below. Here are a few additional points to note:

  • The guideline applies to convulsive status epilepticus.
  • A new level of evidence rating of "U" is utilized. It means "data inadequate or insufficient; give current knowledge, treatment is unproven."
  • It addresses 5 specific questions:
    • Which anticonvulsants are efficacious as initial and subsequent therapy?
    • What adverse events are associated with anticonvulsant therapy?
    • Which is the most effective benzodiazepine?
    • Is IV fosphenytoin more effective than IV phenytoin?
    • When does anticonvulsant efficacy drop significantly?
  • IM midazolam is incorporated as one of the recommended 1st choices of treatment.
  • One of the second phase therapy recommendations is levetiracetam 60 mg/kg! It is a level U recommendation. Be prepared for neurology to request this dose. There is no data in adults to support this high of a dose.


  1. Glauser T, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society. Epilepsy Curr 2016;16(1):48-61. [open-access link]
  2. Harden CL. Commentary on SE guidelines. Epilepsy Curr 2016:16(1):62-3. [open-access link]

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