Treatment of Seizures in the ED

Although most seizures resolve spontaneously in one to three minutes, the seizures we typically face in the emergency department are the generalized tonic-clonic type and have been going on for a longer period of time, usually fulfilling the Neurocritical Care Society guidelines’ criteria for status epilepticus—a continuous seizure lasting more than five minutes, or two or more seizures within a five-minute period without return to neurological baseline in between. We know status epilepticus is associated with a mortality rate as high as 43 percent, and as the duration of seizures increase, the outcomes become poorer, especially in seizures lasting more than 30 minutes, owing to brain anoxia, acidosis, and rhabdomyolysis that occurs with ongoing seizure activity. In fact, the seizure duration is the only potentially modifiable determinant of mortality. It is believed that the longer the seizure, the more refractory to medication it becomes.

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