What is the first line of treatment in status epilepticus according to UK (United Kingdom) guidelines?

From the Guidelines

The first-line treatment for status epilepticus according to UK guidelines is intravenous lorazepam at a dose of 0.1 mg/kg for children, administered slowly over 2-5 minutes, as recommended in the management of severe malaria in children guidelines 1.

Key Considerations

• The dose of lorazepam is crucial, and it should be administered slowly to avoid adverse effects.
• If IV access is not available, other options like midazolam or diazepam can be considered, but lorazepam is the preferred first-line treatment due to its longer duration of action in the brain, reducing the risk of seizure recurrence.
• Oxygen should be administered, vital signs monitored, and the airway protected during treatment.
• Early and effective treatment is crucial as prolonged seizures can lead to neuronal damage, making them increasingly difficult to control and potentially resulting in long-term neurological sequelae.

Treatment Approach

• The treatment approach should prioritize the cessation of seizures as soon as possible to reduce morbidity and mortality, as highlighted in the clinical policy for critical issues in the management of adult patients presenting to the emergency department with seizures 1.
• If seizures continue after 5-10 minutes following the initial dose, a second dose of lorazepam can be given, but preparations should be made to move to second-line therapy if the seizures persist.
• It is essential to search for treatable causes of status epilepticus, including hypoglycemia, hyponatremia, hypoxia, drug toxicity, and systemic or CNS infection, and address them promptly, as recommended in the clinical policy for critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures 1.

Prioritizing Outcomes

• The primary goal of treatment is to prioritize morbidity, mortality, and quality of life outcomes, and the treatment approach should be guided by the most recent and highest-quality evidence available, which in this case supports the use of lorazepam as the first-line treatment for status epilepticus 1.

From the Research

First-Line Treatment for Status Epilepticus in the UK

• The first-line treatment for status epilepticus in the UK is not explicitly stated in the provided studies, but according to the available evidence, benzodiazepines are considered the first-line therapy during the emergent treatment phase of status epilepticus 2, 3, 4, 5, 6.
• Specifically, intravenous lorazepam and intravenous diazepam administered by paramedics are more effective than placebo, and intramuscular midazolam is non-inferior to intravenous lorazepam 2, 6.
• The median time to seizure cessation from drug administration varies from 1.6 minutes to 15 minutes, and the rates of respiratory depression among participants receiving active treatments range from 6.4% to 10.6% 2, 6.

Recommended Benzodiazepines

• The recommended benzodiazepines for the treatment of status epilepticus include:
  • Lorazepam
  • Diazepam
  • Midazolam
• These benzodiazepines can be administered via different routes, including intravenous, intramuscular, and rectal 3, 4, 6.

Importance of Prompt Treatment

• Prompt treatment of status epilepticus is crucial to avoid hospitalization and reduce morbidity and mortality 3, 5, 6.
• The outcome of status epilepticus depends on the underlying etiology, age, rapidity of treatment, and adequacy of care 3, 5.