What are the treatment steps for a hospitalized patient who is actively experiencing seizures?

From the Guidelines

The treatment of a hospitalized patient who is actively seizing should follow a stepwise approach, starting with ensuring patient safety, assessing and securing the airway, breathing, and circulation, and administering supplemental oxygen and establishing intravenous access, then administering a first-line benzodiazepine such as lorazepam 0.1 mg/kg IV, as recommended by the most recent guidelines 1. The initial steps in managing a patient with active seizures include:

• Ensuring patient safety by positioning them on their side to prevent aspiration, protecting the head, and removing harmful objects from the vicinity
• Immediately assessing and securing the airway, breathing, and circulation
• Administering supplemental oxygen and establishing intravenous access
• Checking blood glucose level, as hypoglycemia can precipitate seizures The first-line treatment for seizures is a benzodiazepine, such as lorazepam 0.1 mg/kg IV, which can be repeated once after at least 1 minute if seizures persist, as recommended by the guidelines 1. If seizures continue, a second-line antiepileptic drug such as levetiracetam 40 mg/kg IV bolus can be administered, as recommended by the guidelines 1. For refractory status epilepticus, initiating continuous EEG monitoring and considering anesthetic agents such as propofol, midazolam, or ketamine may be necessary, as recommended by the guidelines 1. Throughout treatment, it is essential to monitor vital signs, obtain laboratory studies, including electrolytes, glucose, toxicology screen, and antiepileptic drug levels if applicable, and identify and treat underlying causes such as metabolic abnormalities, infection, stroke, trauma, or medication effects. The most recent guidelines recommend a stepwise approach to managing seizures, starting with benzodiazepines and progressing to second-line agents and anesthetic agents as needed, as recommended by the guidelines 1.

From the FDA Drug Label

The treatment of status, however, requires far more than the administration of an anticonvulsant agent. It involves observation and management of all parameters critical to maintaining vital function and the capacity to provide support of those functions as required. Ventilatory support must be readily available The use of benzodiazepines, like lorazepam injection, is ordinarily only an initial step of a complex and sustained intervention which may require additional interventions (e.g., concomitant intravenous administration of phenytoin). Because status epilepticus may result from a correctable acute cause such as hypoglycemia, hyponatremia, or other metabolic or toxic derangement, such an abnormality must be immediately sought and corrected.

The treatment steps in a hospitalized patient who is actively seizing include:

• Initial administration of an anticonvulsant agent such as lorazepam injection
• Observation and management of vital functions
• Ventilatory support
• Correction of any underlying metabolic or toxic derangements
• Possible additional interventions such as concomitant intravenous administration of other medications like phenytoin 2

From the Research

Treatment Steps for Hospitalized Patients Actively Seizing

The treatment of seizures in hospitalized patients involves several steps, with the primary goal of stopping the seizure and preventing further seizures. The following are the key treatment steps:

• First-line treatment: Benzodiazepines, such as lorazepam, midazolam, or diazepam, are commonly used as the first-line treatment for seizures 3, 4, 5, 6.
• Route of administration: The route of administration for benzodiazepines can be intravenous, intramuscular, or rectal, depending on the patient's condition and the availability of intravenous access 3, 6.
• Second-line treatment: If the patient does not respond to first-line treatment, second-line agents such as phenytoin, phenobarbital, or valproate may be used 4, 5.
• Monitoring and supportive care: Patients who are actively seizing should be closely monitored, and supportive care, such as maintaining a patent airway, breathing, and circulation, should be provided.
• Treatment of underlying cause: It is essential to identify and treat the underlying cause of the seizure, such as infection, trauma, or metabolic disorders.

Key Considerations

Some key considerations in the treatment of seizures include:

• Time to treatment: The time to treatment is crucial, and delays in treatment can lead to worse outcomes 3.
• Choice of medication: The choice of medication depends on the patient's condition, the severity of the seizure, and the availability of medications 5.
• Dosing and administration: The dosing and administration of medications should be carefully considered, and the patient should be closely monitored for adverse effects 6, 7.