NCCEd: Neurocritical Care Education for Residents

Case-Based Modules > Case 14 > Conclusion

Great job! The patient had a TBI that ended up having intracranial hypertension, but not before developing more overt generalized convulsive status epilepticus. We had to progress through the usual algorithm to stop it, and once we stabilized him from that perspective, we were able to proceed with other key measures like invasive ICP monitoring, and, of course, cEEG.

Pearl 1: The first-line therapy for convulsive status epilepticus is IV lorazepam or IM midazolam.

With IV lorazepam, the overall target dose is 0.1mg/kg, though the recommended maximum dose given at a time is 4mg. Time to action for IV lorazepam is about 3 minutes. IM midazolam 10mg is recommended if IV access is not already established. Time to action for IM midazolam is about 5-10 minutes.

Suggested Reading from this Case:

• Glauser T, Shinnar S, Gloss D, 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. doi:10.5698/1535-7597-16.1.48